Rural 
Hygiene 




Book _ 



OopightN _i 



COPYRIGHT DEPOSIT. 



RURAL HYGIENE 



9 




9 




Rural Hygiene 

A HAND-BOOK OF SANITATION DESIGNED FOR 
THE USE OF STUDENTS IN THE AGRICULT- 
URAL SCHOOLS AND COLLEGES, AND FOR 
THE RESIDENTS OF THE RURAL DIS- 
TRICTS OF THE UNITED STATES 

BT 

ISAAC WILLIAMS BREWER, M.D. 

H 
WITH ILLUSTRATIONS 

SECOND EDITION 






W-7^ 




PHILADE 
J. B. LIP 


LPHIA y 
PINCOTT C 
1913 


LONDON 
:OMPANY 


9 




9 



.B6 



Copyright, 1909 
By J. B. Lippincott Company 

Copyright, 1913 
By J. B. Lippincott Company 



Published October, 1909 



Printed by J. B. Lippincott Company 
The Washington Square Press, Philadelphia, U.S.A- 



©CI.A358520 
*4/ 



This Book is Dedicated 
to THE 

Cotmtrp fl&pgittatia 

OF THE 

United States 

men who are overworked, underpaid, and 
not fully appreciated, but whose work 
is of the greatest value to the nation 



CONTENTS 



CHAPTER PA.GB 

Introduction 11 

I. Work and Recreation 19 

II. Dwellings 24 

Ventilation — Heating — Lighting — Inte- 
rior Arrangements of the House. 

III. Schools 42 

Teachers — Disposal of Excreta — Medical 
Inspection — Backward Children — In- 
struction — When to Send the Child to 
School. 

IV. Water 62 

Wells — Springs — Rain-water — Artesian 
Wells — Surface Waters — Water for Ani- 
mals — Simple Tests for Pure Water — 
Purification of Water — Summary. 

V. Disposal of Excreta 89 

Privies — Cesspools — Water Carriage — 
Sewage Farming, Waring's System, and 
Septic Tanks — Dry Earth System — Pail 
System. 

VI. Food and Diet 103 

Economy in Diet — Meats — Fish — 
Canned Foods — Prepared Foods — Cere- 
als — Legumens — Root Crops — Green 

Vegetables — Fruits — Nuts — Stimulants 
— Garbage, Slops, and other Refuse. 

VIL Wines, Whiskey, and other Alcoholic 

Drinks 121 

vii 



Contents 

CHAPTER PAOB 

VIII. Milk 126 

Milking — The Way Milk Becomes Con- 
taminated — Milk Adulterations — Sterili- 
zation and Pasteurization of Milk — Dis- 
eases Transmitted to Man Through Milk 
— Tuberculosis — Typhoid Fever — Diph- 
theria — Scarlet Fever — Cholera and 
Dysentery — Summer Diarrhoea in Chil- 
dren — Milk Sickness — Ropiness in Milk. 

IX. Ice 148 

Ice-water — Ice-cream and Ices. 

X. Country Stores, Jails, and Good Roads. . 153 

XI. Flies, Manure, and Slaughter-houses.. . 158 

XII. Hogs 167 

XIII. Intestinal Parasites 172 

Round-worms — Tape-worms — Ankylos- 
tomiasis (Miners' or Cotton Mill Anaemia) 
— Trichinosis. 

XIV. Malaria, Tetanus (Lockjaw), Diarrhcea 

and Dysentery 180 

XV. General Rules Regarding Contagious 

Diseases 191 

XVI. Measles and Scarlet Fever 196 

XVII. Diphtheria and Smallpox 202 

XVIII. Whooping-cough and Typhoid Fever 209 

XIX. Tuberculosis 216 

XX. Rabies (Hydrophobia) and Rats 223 

XXI. Pellagra 228 

XXII. Acute Anterior Poliomyelitis 231 



LIST of ILLUSTRATIONS 



FIG. PAGE 

Interior and rear walk of a modern, hygienic cow- 
house Frontispiece 

i. — Showing method of ventilating room heated by- 
stove 31* 

2. — School room showing desks and benches that are 
not fitted to the pupils. Many of the pupils' 
feet do not touch the floor 50 

3. — Filthy privy showing a well so placed that it 
receives the seepage from the privy and ad- 
joining stable 64 

4. — Showing relation of purity of water in well to the 

geological formation 66, 

5. — A well in the suburbs of Washington from which 
a large number of persons draw their drink- 
ing water. It receives the surface drainage 
from the track of a branch of the B. & O. 
Railroad 68 

6. — Sketch of cistern and filter. There is an open 
arch in the central wall through which the 
water after filtering through the sand, coke, 
and gravel enters the side connected with 
the pump and ascends through layers of 
gravel, coke, and sand 76 

7. — The babbling brook. Cool and inviting the 
wayfarer to quench his thirst. This stream 
receives the drainage from a number of 
privies and manure piles but a short distance 
above this point 78 

ix 



List of Illustrations 



FIG. PAGE 

8. — Railroad crossing Cochituate Lake from which 
comes part of the water supply of Boston. 
The drainage from the tracks is directly into 
the lake 79^/ 

9. — Forbes water sterilizer, from a cut furnished by 

the Forbes Company 86 

10. — Sewage disposal plant, septic tank, and irrigation 

plant 95 

11. — Self-acting peat-dust closet. The lid is replaced 
by a hinged reservoir containing the peat 
dust. Whenever this is let down a certain 
quantity of peat dust is discharged auto- 
matically and thrown upon the night soil ... 98 

12. — Filthy cow stable. Milk from this dairy was 
being sold in one of the largest cities in the 
country 130 

13. — Milkers with modern pails, Walker-Gordon dairy 131 

14. — (a) Separate parts of Gurler covered pail 134 

14. — (6) Gurler covered pail equipped with absorbent 

cotton strainer ready for use 135 

15. — Insanitary dairy showing improper method of 
caring for milk cans, which are placed to 
drain in the vicinity of the pig pen 1 56 

16. — This is a plate of jelly over which a fly, taken 
from a butcher's stall in the Washington 
Market, walked. The dark spots are colonies 
of germs left on the plate by the fly feet. 
The plate was incubated for 24 hours and 
then photographed by Dr. Wm. Gray 158 

17. — Resting position of Culex (at left) and Anopheles 

(at right) 181 

x 



List of Illustrations 



FIG. PAGE 

1 8. — At top, half -grown larva of Anopheles (malarial 
mosquito) in feeding position, just beneath 
surface of water. At bottom, half-grown 
larva of Culex in breathing position. Greatly 
enlarged 182 • 

19. — "The fly which does not wipe his feet " 213 / 

20. — The faeces of this animal contained large num- 
bers of tubercle bacilli 220 * 

21. — An apparently healthy cow recently in a herd 
supplying milk to Washington, D. C. Tu- 
bercle bacilli were found in her milk and 
fasces. When killed her udder and intestines 
were found to contain small tubercular 
nodules 221- 

22. — (a) Mesentery of the preceding cow showing 

tubercular nodules 221/ 

22. — (6) Part of chest wall of the same cow showing 

tubercular nodules 221 



INTRODUCTION 



Our modern word hygiene comes from 
"Hygieia," the Greek goddess who guarded the 
health of the people. In our modern civiliza- 
tion she has become the greatest of all the gods. 

Hygiene is defined as "that department of 
medical science which concerns the preserva- 
tion of health" and as "a system of principles 
or rules designed for the preservation of health." 
Doctor Parkes, who was one of the greatest 
authorities on hygiene, said, "It aims at ren- 
dering growth more perfect, decay less rapid, 
life more vigorous, death more remote." 

Rural hygiene is a system of rules designed 
for the preservation of the health of those who 
reside in the rural districts. We have been 
taught that the country is more healthful than 
the city and have accepted this without com- 
ment, but recently sanitarians have called 
attention to the fact that the death-rate in the 
cities is falling more rapidly than in the rural 

ii 



Introduction 

districts. The cause of this is simply a matter 
of sanitation. When this country was first 
settled the population was scattered and the 
virgin soil was not polluted, the waters were 
pure, and many of the contagious diseases 
which now claim thousands were practically 
unknown. Man in a primitive state was re- 
quired to pay but little attention to sanitation, 
but as population became more dense it was 
found necessary to appoint persons to advise 
the community in regard to the prevention of 
disease and to enforce rules for the conserva- 
tion of the public health. Generally these 
officers have confined their activities to the 
cities and towns, leaving the smaller villages 
and the isolated farmers to shift for themselves. 
In some of the States considerable attention 
has been paid to rural sanitation; this is 
especially the case in Michigan. 

The following table, compiled from the 
reports of the United States Census Bureau, 
shows the death-rates in the cities and in the 
rural communities of what is known as the 
registration area of the country (that portion 
where fairly accurate statistics of deaths are 
kept). 

12 



Introduction 

Average Rate per 100,000 for the Five Years 
Ending with 1904. 

Death-rate 
Diseases City Rural 

Typhoid fever 25.8 27.8 

Malarial fever 3.8 4.7 

Smallpox 3.4 1.5 

Measles 11. 9 7-7. 

Scarlet fever I 5«7 7-° 

Whooping-cough 12.0 9.1 

Diphtheria 42.9 20.1 

Influenza 17.6 29.3 

Dysentery 8.6 11. o 

Consumption 1 89 . 1 129.3 

Venereal diseases 4.4 1.7 

Alcoholism 7.0 3.4 

Nervous diseases 39-8 24.6 

Pneumonia 151.6 99. 7 

Diarrhoea and enteritis 140 . 7 80 . 2 

Violence 105 . 9 84 . 5 

From the above table we learn that the 
death-rate from malarial fever, influenza, and 
dysentery is greater in the rural districts. It 
is also probable that many cases of death from 
typhoid fever which are charged to the cities 
were in reality contracted in the rural districts. 

It is to be assumed that the average man 
wishes to live as long and as comfortably as 
possible and that he desires to enjoy good 
health as long as he lives. Unfortunately our 
educational system does not provide our people 

13 



Introduction 

with sufficient knowledge on the subject of 
hygiene to enable them to guard intelligently 
their health. Most of us are very ignorant of 
the rules of sanitation, especially those who live 
in regions where the population is scattered. 
The general works on hygiene deal for the most 
part with conditions as they exist in the large 
communities, and, where rural conditions are 
mentioned, they aim at the ideal. The lan- 
guage in these is generally technical and very 
confusing to the ordinary person. True, the 
several State Boards of Health are now issu- 
ing most admirable pamphlets dealing with 
rural conditions, but their form is such that 
they are not readily available and often those 
persons most in need of them are unable to 
obtain the reports desired. It has, therefore, 
seemed that a hand-book written in plain 
language, free from technicalities, aiming to 
be practical, and recognizing the limitations of 
rural life, would be acceptable to those who from 
necessity or choice reside in the rural districts. 
The author has set for himself this task, 
hoping thereby to help some of his fellow 
countrymen to enjoy better health than would 
be possible without the knowledge contained 

14 



Introduction 

in this small volume. He does not claim any 
originality, but has drawn freely from the work 
of a host of physicians, scientists, and agri- 
culturalists who, in the laboratory or in the 
field, have laid the broad foundations upon 
which the science of sanitation rests. 

Some of our people have a strong prejudice 
against living in the country, yet there are many 
advantages in such a life. The principal ones 
are, an abundance of fresh air and sunshine, the 
small number of persons to a given area, more 
out-door life, and plainer, simpler, and fresher 
food. All of these tend to produce strong, 
healthy persons. The disadvantages are, lack 
of society and recreation, exposure to the 
weather, poorly ventilated and heated dwell- 
ings and schools, lack of medical attention, 
danger from polluted water, and the disregard 
of the sanitary laws. 

Doctor Henry W. Acland, Regius Professor 
of Medicine at Oxford, writing in 1884, said, 
"The health, then, of a village depends chiefly 
upon these factors : 

"1. The dwellings. 

"2. The water supply. 

"3. The removal of refuse and drainage, 
is 



Introduction 

"4. Education and inheritance. 
"5. Occupation and recreation. 
"6. Care of the sick." 

Our interpretation of these requirements has 
changed somewhat since they were written, but 
it has only broadened in most instances as we 
have learned more of the causes of disease. 
Probably we do not give as much weight to 
inheritance as was formerly the case, but there 
is little doubt that it plays an important part 
in the predisposition to disease. 

The child of American parentage born in the 
country may well be proud of its heritage, 
endowed with a strong body, a sound mind, 
and the blood relation of many of the leading 
men of the nation, who were also bred in the 
rural districts. 

There is a steady stream of strong, healthy 
men and women moving from the country to 
the city. Among them are those destined to 
rule the land, but in two or three generations 
their race will vanish and give place to the 
children of the less fortunate brothers and 
sisters who have developed strong bodies and 
sound minds amid the hardships and disad- 
vantages of the life in the country. 

16 



Introduction 

In the pages which follow it is the intention 
to discuss the various phases of life in the coun- 
try from the standpoint of the sanitarian, 
endeavoring to point out where we depart from 
the standards fixed by students of hygiene 
and showing how these faults may be corrected. 

I am indebted to my sister Miss Kate Brewer 
for assistance with the manuscript; to Major 
P. M. Ashburn for reading the manuscript and 
for many valuable suggestions, and to Dr. 
D. S. Lamb of Washington for reading the 
proof. 



Rural Hygiene 



i. 

WORK AND RECREATION 



The old adage, "all work and no play makes 
Jack a dull boy" applies to many of the resi- 
dents of the country. Excepting the few rich 
persons who have homes in the rural districts, 
most of the inhabitants are overworked and 
have very little time for relaxation. The 
farmer is constantly in the presence of his 
labor, and his livelihood depends upon so many 
things over which he has no control that he 
must be on the alert at all times to save his 
work from destruction by the elements. The 
city worker who dwells in the suburbs spends 
a large part of his time going to and from his 
work and has very little time for pleasure. 
The women of both classes lead a life of isola- 
tion, which does not conduce to the best 
development. All persons need a change of 

19 



Rural Hygiene 

surroundings and a period of relaxation each 
year. The residents of the city have theirs 
in the summer months when they are found 
at the resorts on the sea-shore and in the 
mountains. The country people should have 
their vacation, but as a rule it is better for 
them to leave home in the fall or winter when 
the pleasures of the city can be enjoyed. The 
aim should be to have as complete a change as 
possible. Those who live in the interior of the 
continent will be greatly benefited by a sojourn 
at the sea-board, not necessarily at the shore, 
but in such cities as New York, Boston, or the 
southern ports, where the benefits of the sea 
air and the sea foods may be obtained. 

To overcome the isolation, each neighbor- 
hood should have its club for men and women 
where the community can gather and discuss 
the topics of the day and exchange ideas. For 
the younger members there should be basket 
ball, bowling, and other in-door sports for 
winter, and in summer provision should be 
made for tennis, croquet, and other games. 
The singing classes and socials are to be encour- 
aged and there should be lectures and lantern 
shows. These latter can be given in any large 

20 



Work and Recreation 

room and the slides can be rented at very- 
reasonable rates. In England where such clubs 
have been in operation for some time the 
results have been most satisfactory. 

The trolley lines reaching out into the coun- 
try are doing great things for the communities 
through which they run, bringing within reach 
of the rural inhabitants many of the advantages 
of the city. 

One of the best things ever done by the 
Federal Government was the establishment of 
the rural free delivery. This system should be 
extended so as to reach a larger number of 
persons. 

The country stores should no longer be the 
political and social centres of the community; 
from a sanitary point they are anything but 
desirable gathering places. 

The front-door garden has to a large extent 
disappeared from the farm. Those who culti- 
vate flowers send them to the cities and the 
rural dwellers see but few of them. Yet bright 
flowers and ornamental shrubs are important 
factors in mental hygiene and our agricul- 
tural societies and fairs could well expend 
more of their energy in fostering the flower- 

21 



Rural Hygiene 

garden by offering prizes for the best grown 
for home use. 

The large cities have absorbed the best of our 
religious thinkers, in many instances leaving the 
unsuccessful clergy to the country parishes. 
This is far from what it should be. Let the 
country churches be rilled with strong men of 
action who will be a force in the community. 
To obtain such men they must be paid a proper 
salary, not in the shape of potatoes and turnips, 
but in the same cash which the other members 
of the community expect for their services. 
In like manner the doctor should be properly 
paid. In many cases at present he is over- 
worked and underpaid and cannot devote his 
time to many matters which are of the greatest 
importance to the community at large, but 
which bring in no income. The local physician 
should always be on the school-board, and he 
should be paid for visiting the schools at regular 
intervals. He too must have his vacation. 
This he will not use for his own good but will 
spend in some medical centre fitting himself to 
do better work for you when he returns. 

Do not look down on the "country doctor" 
for the world owes him much. Vaccination to 

22 



Work and Recreation 

prevent smallpox was introduced by a country- 
doctor. Some of the greatest surgeons in 
America have lived and practiced in small 
towns. Robert Koch was a country practi- 
tioner when he made some of his most impor- 
tant discoveries and it was while a country 
doctor that he evolved fundamental methods 
of work and observation that culminated in 
those classical researches that made him 
famous. 



II. 

DWELLINGS 



The experience of ages has taught the human 
race to build on elevated ground where the soil 
is comparatively dry. Generally sand or gravel 
is the best soil, w T hile clay is the worst. 

The exposure of the building is of the great- 
est importance. In the cities buildings must 
be erected according to the direction of the 
street, and the owner can do nothing to im- 
prove the facing of his house. This is often 
true in the suburban districts, but there the 
owner frequently has sufficient ground to pro- 
vide for a side entrance, in which case he can 
usually so place the house as to have the maxi- 
mum exposure to the sun. 

In the United States, dwellings usually face 
the south, but a southeastern exposure is pre- 
ferable as the sunlight will then penetrate into 
each room at some time of the day. In this 
connection the prevailing winds must be con- 
sidered, it being desirable to expose the build- 

24 



Dwellings 

ing to the cooling winds of summer and at the 
same time have shelter from the storm winds 
of winter. Generally the southern or south- 
western slope of a hill will afford all the pro- 
tection desired. In flat country it may be 
necessary to plant pines or other evergreens as 
wind-breaks. 

The outlook from the windows is not a mat- 
ter of secondary consideration but one of 
considerable sanitary importance. Generally 
speaking, the rooms which are the most occu- 
pied should command the most pleasing view; 
especially is this important in the case of the 
dining-room. A dark, unattractive room that 
looks out upon another building or upon 
parched fields does not conduce to a cheerful 
meal and a good appetite. 

Before the foundation is laid the ground to 
be occupied must be thoroughly drained to a 
depth of at least a foot below the floor of the 
cellar. This may be done by the use of open- 
joint tile drains or by trenches partially filled 
with broken stone and covered with earth. 
The water will run through the spaces between 
the stones, but the trench must empty at a 
level considerably below that of the cellar floor 

25 



Rural Hygiene 

to prevent the water from backing up in the 
drains. There are some localities where it will 
be impossible to drain the ground under the 
house. There it becomes necessary to build 
upon piling. 

The foundation is to be laid in concrete and 
the walls to the level of the ground are to be 
of brick or stone, which should be covered on 
the outside with pitch to the level of the ground. 
At this point there should be, in brick buildings, 
a layer of slate or other impervious substance 
to prevent the dampness from travelling up the 
wall. 

Brick and stone are preferable for building 
materials, and in most parts of the country 
are as cheap as wood. Cement is becoming 
quite popular in some sections and it is claimed 
that a cement house can be built much cheaper 
than any other. If the building is of brick or 
sandstone it is often necessary to cover the 
outer wall with tar or other material to prevent 
dampness. Slate makes the best roofing, but 
it is more costly than shingles. Tin answers 
very well, but is hot in summer and does not 
last well. Shingles are cheap, but after a time 
have to be replaced, and where a cistern is 

26 



Dwellings 

used they often impart to the water an tin- 
pleasant taste. Slate is the best roof from 
which to collect water for drinking. Eaves- 
troughs must be provided to conduct the water 
from the roof away from the foundation. 

The best floor for the cellar is concrete covered 
with cement. Rammed clay is not so good but 
will answer, as will also brick covered with tar. 
The object to be attained is the exclusion of 
moisture, the ground air, and rats. This por- 
tion of the house is often insufficiently lighted 
and ventilated, which in some cases may cause 
ill health. The same relative quantity of fresh 
air should be admitted to the cellar as is pro- 
vided for the rest of the house, and at least two 
feet of each window should be above grade. 
The windows must be so arranged as to admit 
as much sunlight as possible. All openings 
about the water or other pipes must be made 
rat proof by being closed with cement. 

The division of the house into rooms is to 
be left to the individual taste of those who are 
to occupy it. In general no room should be 
smaller than ten feet by ten feet, and there 
should be doors communicating with the ad- 
joining rooms. The window space must not be 
less than one-fifth of the floor space. 

27 



Rural Hygiene 

For each adult a floor space of fifty square 
feet, and an air space of not less than six hun- 
dred cubic feet must be provided. Smaller 
rooms are harder to ventilate, and a greater 
height than ten feet adds to the cost without 
adding to the sanitary condition of the build- 
ing. The ventilation is much better in rooms 
with windows extending to the ceiling. Where 
the exchange of air is through the windows 
all the space above the top of the window is 
practically useless as the air in that portion of 
the room is rarely changed. 

VENTILATION 

An abundance of fresh air is absolutely neces- 
sary for the health of the body. If we lived in 
the open air the question would be of very little 
interest, but, being inhabitants of buildings, it 
becomes one of the greatest importance ; so much 
so that there is a magazine published for the 
sole purpose of inducing people to be in the 
open air as much as they can, and, if this is 
impossible, to let as much air in the house as 
possible. The air that is expelled from the 
lungs contains many impurities derived from 
the body, the principal one being carbon dioxide, 



Dwellings 

a gas which is found in small quantities in the 
atmosphere and which is one of the foods for 
vegetation. That the air in the house should 
be pure there must be a constant interchange 
between it and the outer air. This exchange is 
called ventilation. 

As a result of many experiments it has been 
proven that for each adult there must be not 
less than six hundred cubic feet of air in the 
room, and that this must be changed at least 
five times an hour if the air is to remain pure. 
How to accomplish this without causing 
draughts or unnecessarily cooling the air in 
the room is far from a simple problem. Elab- 
orate mechanical apparatus has been devised 
to provide ventilation for buildings, but as a 
rule the cost precludes its being adopted in 
private dwellings. For many years to come the 
majority of our people will ventilate their 
homes through the windows. 

Air is like water in that there must be a place 
for it to overflow or flow out as well as an inlet. 
Many persons do not appreciate this and we 
find them endeavoring to ventilate through 
only one opening. Where the air space does not 
fall below the standard set above it is possible to 

29 



Rural Hygiene 

obtain the required quantity of air by opening 
one window at the top and another at the bot- 
tom. These should be as far apart as possible. 
This method causes draughts, and many of our 
people prefer bad air to cold air or a draught. 
The draught, however, may be avoided by plac- 
ing a board beneath the window that is open at 
the bottom. The air will then enter between the 
two sashes and be directed upward and diffuse it- 
self through the room without inconvenience to 
the occupants. Open fires are credited with aid- 
ing ventilation very much and without doubt 
they do create a movement of air up the chimney, 
but most of the air is drawn from the lower 
levels and the foul air which rises to the ceiling 
is rarely disturbed. Where stoves are used an 
abundant supply of pure warm air can be had 
by enclosing the stove in a drum which con- 
nects with the open air through a shaft. The 
air is warmed as it passes through the drum 
and is diffused throughout the room. An out- 
let must be provided. Where the building is 
but one story high two air shafts may be ex- 
tended downward from the roof into the room ; 
the outlet should terminate at the ceiling, but 
the inlet must extend several feet lower or it, 

30 






Dwellings 




COLD AIR DUCT TO*-- / « 
( CONNECT WITH OPENING/ ill 
IN OUTRIDE WALC^- Voah^r( 



Fig. i. — Showing method of ventilating room heated by stove. 



31 



Rural Hygiene 

too, will become an outlet. These may open in 
the wall, but wherever they are a valve must 
be so constructed as to regulate the movement 
of the air. 

The senses soon become accustomed to the 
air in which we are, even though it be much 
vitiated, therefore rooms which seem stuffy at 
first do not appear so after a while. To deter- 
mine, the purity of the air elaborate instruments 
have been devised, but any one can form a 
pretty fair estimate of the quality of the air in 
a room by entering it directly from the fresh 
air or from a well -ventilated room. If the air 
contains less oxygen than normal it will seem 
stuffy. 

HEATING 

Closely associated with ventilation is the 
question of heating the house. The source of 
heat is governed by the fuel supply and the 
ability of the householder to install modern 
apparatus. The usual sources are open fires, 
stoves, furnaces, steam heaters, hot water, and 
gas or oil stoves. 

Furnaces furnish a very dry heat that fre- 
quently has an unpleasant scorched odor from 
the burning of the organic matter in the air. 

Z2 



Dwellings 

They aid the ventilation very much but in 
general they are not satisfactory for the reasons 
mentioned. Hot water and steam are more 
satisfactory, but the cost of installation is 
generally too great for most persons. For many 
years the country houses will be heated by 
stoves. These can be made satisfactory if 
properly handled. The old-fashioned Franklin 
heater is very satisfactory and a great saver of 
fuel. It has been adapted to burning coal. In 
the southwest the air-tight stove is much used. 
It is a wood burner and furnishes an abundance 
of heat with the minimum consumption of fuel. 
The fire is built of small wood which is allowed 
to burn to a red coal, larger sticks being then 
added and the stove closed up tight. Such a 
fire will keep all night and give out sufficient 
heat to warm a room. In the morning the open- 
ing of the draught causes the charred wood to 
blaze up. 

Electricity will ultimately be the method by 
which we will heat our houses. It will cause a 
great saving of fuel and at the same time do 
away with many of the bugbears of the present 
methods. 

Oil and gas stoves are objectionable because 
3 33 



Rural Hygiene 

they consume a large quantity of oxygen and 
at the same time generate a large quantity of 
carbon dioxide. 

One of the most dangerous heaters is the red 
hot stove. It certainly causes much warmth, 
but at the same time carbon monoxide, an 
odorless but highly poisonous gas, is passing 
through the iron and polluting the air. This gas 
combines with some of the elements of the blood 
and causes serious illness when any consider- 
able quantity is breathed. 

LIGHTING 

For a long time to come oil will furnish the 
illumination for the greater part of the resi- 
dences of rural districts. It is important to 
use only the very best grades of oil, as the light 
is much better and at the same time the impuri- 
ties given off are much less. The student's 
lamp furnishes a soft and pleasant light. The 
Rochester burners use a large quantity of oil 
and give a brilliant light, but it is glaring, and 
they also generate an immense amount of heat. 
A soft white light is the best for the eyes. 

Where electricity can be had it is the most 
desirable light. The cost of installation will be 

34 



Dwellings 

considerable, but the saving in the light and 
the improvement in the air of the house will 
in time pay it back. The light can be tempered 
by the use of proper globes, and the eyes should 
be benefited by the use of electricity. 

INTERIOR ARRANGEMENTS OF THE HOUSE 

The housekeeper in the rural districts is 
overworked, and for her sake, as well as for 
the health of those who live in the house, the 
ornamentation on doors, windows, and stairways 
should be reduced to the minimum. The door 
of the room in which this page is being written 
is made of fifty-three pieces. This door no 
doubt costs less than a solid one but it is any- 
thing but beautiful and has many cracks for 
the lodgement of dust and dirt. 

The cracks in the floor may be filled with 
crack filler which will greatly reduce the quan- 
tity of dust in the house. Rugs are more easily 
cared for than carpets and are far more sani- 
tary. Draperies are very unsanitary, especially 
when multiplied about windows and doors. 
Shades are needed to temper the light at times 
and to exclude the gaze of outsiders, but they 
should not be kept drawn all the time. Carpets 

35 



Rural Hygiene 

and rugs will undoubtedly hold their color 
better in the dark, but the germs of tuberculosis 
and other diseases live much longer in dark 
rooms. The sun is, in fact, one of the most 
efficient disinfectants known. The question 
therefore resolves itself into color of carpets 
and rugs versus the health of the family and 
we of the jury decide in favor of good health. 

The housewife has to make innumerable 
trips to the upper portion of the house and for 
her convenience alone, if for no other reason, 
the stairs should be low and devoid of the turns 
which are so frequently found in modern houses. 

Bedrooms must be furnished as simply as 
possible yet with due consideration for the com- 
fort of the occupants. Running water in the 
room is very convenient, but it is not desirable 
from the sanitary standpoint. It is important 
to have as much sunlight as possible in the 
room and the ventilation must be as good as 
possible. At night the windows should be wide 
open. The storm windows and doors found 
in our northern houses in winter are an abomi- 
nation and should not be used unless absolutely 
necessary. The principal objection to having 
the window open at night is that in the morning 

36 



Dwellings 

the room is too cold for dressing. This can be 
obviated by using an adjoining apartment for 
a dressing-room. The more air in the sleeping- 
room the better. Many persons are now sleep- 
ing out of doors all the year round even in the 
severest of our northern winters, and there is 
no reason why healthy persons should not sleep 
with the windows wide open. 

The bathroom should not be tucked away in 
an out-of-the-way corner, but must be con- 
venient, large, well lighted and ventilated. 
Place the tub in the center of the floor so that 
there will be no place behind it that cannot be 
kept clean. There is no reason why it should 
not be built into the room so that there will be 
no space beneath it to collect dust. The dis- 
charge pipe can be run out at one end and thus 
all the requirements of exposed pipes will be 
met. Enamelled tubs only should be used. 

Probably the most important room in the 
house from a sanitary point of view is the 
kitchen. It should be large and as conven- 
iently arranged as possible, and where practi- 
cable there should be an adjoining room for a 
laundry. A sitting-room for servants will add 
greatly to their comfort, making them more 

37 



Rural Hygiene 

contented. This is also important to the health 
of the family as it reduces the exposure of the 
food to a minimum number of persons. Have 
plenty of fresh air in the kitchen and provide an 
abundance of hot water, also, if possible, run- 
ning water and a sink. Most kitchen sinks are 
provided with a grease trap which can be 
opened when it clogs up. Where this is not the 
case the pipe should be flushed daily with very 
hot water and lye. 

The pantry must have sufficient shelving to 
hold the needed supplies and is to be made as 
near insect- and rat-proof as possible. In some 
houses the pantry is dark and poorly venti- 
lated, the idea being that foods keep better in 
such rooms. This is far from the truth. Any 
articles that will spoil if exposed to the light 
should be kept in drawers or in jars with tight- 
fitting covers. 

In the summer all the windows and doors 
throughout the house should be provided with 
wire screening of from eighteen to twenty 
meshes to the inch, so as to exclude mosquitoes 
and flies. Where there are no mosquitoes or 
any very small flies a larger mesh may be used 
and the cost will be reduced. Copper wire 

38 






Dwellings 

costs more than ordinary iron wire, but it lasts 
longer and is not so readily broken. If it is im- 
possible to screen the entire house, the kitchen, 
pantry, and dining-room should be screened, 
for it is of the greatest importance to exclude 
flies from these rooms. When this is impos- 
sible wire dish covers may be used, but no food 
should be left uncovered where flies can get at 
it. There is little doubt that a large number of 
typhoid fever cases are contracted from eating 
food that has been contaminated by germs from 
the legs of the fly. 

The foregoing description of a home is as we 
should like to have it, but the majority of our 
people do not build their own homes and must 
make use of the buildings that are on the farm. 
In such a case it is well to remember that the 
cardinal sanitary points about a house are 
freedom from dampness ; light and sunshine in 
every room ; large windows, sufficient air space, 
good ventilation, and sufficient heat. These 
should be had at any cost. The air space is 
generally insufficient, but that can be met by 
limiting the number of persons to the room. 
Sometimes several small rooms can be merged 
into one room, thereby improving the venti- 

39 



Rural Hygiene 

lation and reducing the cost of light and 
heat. Not infrequently the stairs are dark and 
without ventilation and this should be remedied 
by some means or other. 

The all-important room is the kitchen. It 
must be kept free from flies and should not be 
the place for hanging the outer garments of the 
family. These are generally dusty and in some 
cases smell of the stable or soil. Running 
water is very desirable, and where it cannot be 
had provision must be made for an abundant 
supply from some other source. A large hot- 
water tank is a necessity. 

The surroundings of a country house should 
be well kept, the garden being filled with orna- 
mental shrubs and flowers. There should be 
no backyard littered up with cans, ashes, and 
other refuse, but there should be some portion 
of the grounds, close to the house set apart 
for the use of the children. There they should 
be allowed to dig and build to their heart's 
content. Encourage them to spend their time 
at home where they will be under the eyes of 
their elders and they will learn less that is 
undesirable. Their morals will be on a higher 
level and there will be fewer wild oats to harvest 

40 



Dwellings 

in later years. Children, however, should be 
taught the rudiments of sanitation at an early 
age, and should learn how to keep their 
playground free from cans, broken bottles, and 
other refuse. These things must be burned or 
buried. There is a great difference between the 
sanitary playground and the useless city park 
with its "keep off the grass" placards. Let us 
increase the former but diminish the latter. 



III. 

SCHOOLS 



In the "little red schoolhouse" many of our 
greatest men began and completed their school 
education, yet there can be no doubt that there 
were others who would have been great but for 
the limitations of the rural school. It is a sad 
fact that the instruction in many of our rural 
districts is far behind the times, that the school 
buildings are in many instances far from sani- 
tary, and that the work imposed upon the 
teachers is greater than they can perform with- 
out losing their health. Our statesmen boast 
very much of our schools. We frequently hear 
it said that the "public schools are the bulwark 
of the nation " and yet the nation has done very 
little for the oublic schools. 

TEACHERS 

Most of the rural school teachers are women, 
many of them not physically fit for the task 
before them. Their pay is very inadequate and 

42 



Schools 

a disgrace to the nation. They receive less 
than the man who works with the pick and 
shovel, and very much less than the politicians 
who in many cases return little or nothing for 
the money paid them. Often the salary does 
not allow them to live properly. I know a 
young woman who teaches a lot of unruly 
negroes in a district school in the middle west 
for twenty-five dollars a month for ten months, 
in all two hundred and fifty dollars a year. 
Out of this she pays twenty a month for her 
board, or two hundred dollars a year, leaving 
but fifty dollars for clothing and for her support 
during the summer months. There are many 
worse cases than this. In some schools the 
teachers are paid less than the farm hands but 
are boarded around among the farmers. 

The work of the rural teacher is harder than 
that of the city teacher. She is generally 
required to teach all grades, and not infre- 
quently has to manage grown boys and unruly 
men. Overworked and underpaid, she cannot 
render the best service to the community. 

If the rural communities cannot properly 
support their schools, and it seems that such is 
the case, then the State or Federal Govern- 

43 



Rural Hygiene 

ment must do so. The States are limited in the 
amount of money they can raise by the direct 
tax, while the Federal Government, by indirect 
taxation, can raise an unlimited amount. 
There are many economies which the Federal 
Government can practice without in any way 
embarrassing its efficiency, and the farmer, who 
holds the balance of power, should see that they 
are made and the funds thus released used for 
the betterment of the rural schools. 

The isolated country school can no longer 
furnish adequate accommodations for the chil- 
dren of the rural districts and in some of the 
States school districts are being consolidated in 
order to provide larger and more modern 
buildings and laboratories. This should not be 
done with an idea of economy but rather to 
obtain better instruction, to lighten the work 
of the teachers, and at the same time to pay 
them better. Where the consolidated district 
covers a large area it may be necessary to pro- 
vide free transportation for those children who 
reside in the more remote parts of the area. 

The ideal consolidated school will provide a 
suitable building for instruction and a home for 
the teachers. It will be surrounded by ample 

44 



Schools 

grounds which will include playgrounds and a 
flower garden tended by the children. 

In some of the public schools hot lunches are 
being provided for the children. This is not 
so much needed in the rural schools, but there 
are without doubt many children who will be 
able to do better work during the afternoon 
session if they have a good meal at noon. 

The view from the school should be as pleas- 
ing as possible. A north light is said to be the 
best for the eyes, but a south light is about as 
good, and besides allows the sunlight to pene- 
trate the rooms, a much desired feature from a 
sanitary point of view. This exposure will 
generally be recommended. The exterior archi- 
tecture should be rather plain but pleasing. 
The interior decorations are to be considered as 
one of the object lessons and should be in good 
taste but free from the* 'fancy work" which 
adds nothing to the beauty and only collects 
dust. 

The tendency is to make the rooms too large 
and too high. Each pupil requires about twenty 
square feet of floor space and not less than two 
hundred and fifty cubic feet of air space. 
Oblong rooms are best suited to school pur- 

45 



Rural Hygiene 

poses and those that are between thirty and 
forty feet in length are the most satisfactory. 
Thirteen feet is about the proper height. 
Increased height only adds to the cost of heat- 
ing without adding to the comfort or efficiency 
of the pupils. The window area must not be 
less than one-fifth of the floor space. It is best 
to place the windows at the back and on one 
side, the object being to have the light come 
from the rear and over the left shoulder of the 
child. The sill of the window should be five 
feet from the floor and the window should 
extend to the ceiling no matter what the archi- 
tects say about beauty. Inside blinds are 
needed to shut off the light when excessive. 
They should slide down into the space below 
the sill so as not to cut off the light on dark 
days. This space must be entirely open or it 
will accumulate dirt. Storm windows may be 
needed in very cold climates but they cut off 
much of the air required for the ventilation of 
the room. The furthest desk should not be 
more distant from the window than one and 
one-half times the height of the window. 

The ventilation should be as perfect as pos- 
sible, the aim being to keep the air as pure as 

46 



Schools 

that outside. It has been ascertained that not 
less than thirty cubic feet of fresh air must be 
furnished each pupil per minute if the air in the 
room is to be kept free from impurities. Where 
there is a mechanical ventilating system this 
will be comparatively easy to secure, but in 
most of the country schoolhouses no provision 
has been made for ventilation, and the only 
way to introduce fresh air and get rid of the bad 
is through the windows and the cracks about 
them and the doors. In such rooms the prob- 
lem is very difficult because of the draughts 
which are created. The methods of ventilat- 
ing buildings have been considered under hous- 
ing, and as the methods of providing air for 
schools are the same the question will not be 
considered further in this place. During recess 
all the windows should be open and all children 
made to leave the room. 

The heating is a matter of great importance. 
In the consolidated schools it will be possible 
to heat from a central plant in the basement and 
so dispense with the dust and dirt incident to 
stoves or fireplaces. For such plants steam or 
hot water will be found the most satisfactory. 
The heat from furnaces is too dry and often 

47 



Rural Hygiene 

contains carbon monoxide, a most dangerous 
gas which is given off from red hot iron. There 
is a popular belief that steam- and hot water- 
heat are moist. This is not so, as none of the 
steam or the water comes in contact with the 
air of the room, the heat being radiated from 
the heated pipes. 

The small country school will for many years 
be heated by a stove. To have this a success the 
teacher must give it constant supervision. It 
must never be allowed to become red hot, but 
must furnish sufficient heat without having any 
of the ventilating openings closed. Stoves 
require a large quantity of air, and where they 
are used some provision for extra air must be 
made. A good way is to enclose the stove in a 
sheet iron drum, leaving an air space of from 
six inches to a foot around the stove. The top 
of the drum is left open, while the bottom is 
connected with the open air by means of a 
flue, which must run as straight as possible. 
This flue should never be beneath the floor of 
the cellar, nor should it open on the level of the 
ground or where the air is befouled from any 
cause. Such stoves greatly aid in the ventila- 
tion of the room and furnish warm air with- 

48 



Schools 

out causing draughts. The flue will not work 
unless some outlet is provided for the foul 
air of the room. Some of this will pass out 
through the stove, but most of it must escape 
through the windows or through a shaft in the 
ceiling. 

The blackboards are to be placed on the wall 
opposite the windows and are to be of a dull 
black color so as to diminish the reflection. 
They must not be further than thirty feet 
from the most distant seat. If kept very clean 
the writing will be more readily seen and the 
strain on the eyes will be much reduced. 

It is generally recommended that the walls 
be neutral in color, but the greens and blues 
are most restful to the eyes. Painted walls are 
the most satisfactory, as they can be cleaned 
with soap and water. 

It is not uncommon to find schoolhouses 
with such thin floors that the children's feet 
are always cold during the winter months. 
This undoubtedly accounts for some of the 
colds and catarrhs from which so many children 
suffer. Double floors are just as necessary in 
the school as in the home. All the cracks should 
be filled with crack filler, which will reduce the 

4 49 



Rural Hygiene 

dust in the room to a minimum. A room that 
is so dusty that the children cannot sing while 
marching is not fit for a school. 

The cellar under the building should be 
as clean and dry as the rest of the school. 
Under no circumstances should it be a stor- 
age place for broken furniture, ashes, and 
other rubbish. 

A separate locker or closet should be pro- 
vided for each pupil's wraps, and must only be 
used by the occupant of the desk to which it 
belongs. It should be warm and dry and 
well ventilated. Daily inspection should be 
made to insure its cleanliness and to prevent 
its becoming the storage place for all kinds of 
rubbish. Once a week it should be washed 
with hot water and soap and left standing open 
from Friday night until Monday morning. 
These precautions will reduce the amount of 
sickness in the school and be a direct financial 
saving to the community. 

All desks and benches should be adjustable. 
The desk should be an inch higher than the 
elbow of the child when standing, and the seat 
at such a height that the child's feet will rest 
flat on the floor when the thighs are horizontal. 

50 



crtc 



n 









S2.3 



60 O 



St3 



«< 

O 




Schools 

These precautions are necessary, as too high 
or too low desks and benches are often the 
cause of deformities, such as curvature of the 
spine. The illustration, which shows desks and 
seats at improper heights, was taken in a school 
but nine miles from one of the largest cities in 
the country. 

An abundance of pure water is necessary. 
It is not advisable to keep the drinking water 
in the school room, but it should be placed in 
the corridor convenient to the class rooms. 
There is no doubt that many of the diseases 
from which children suffer are transmitted by 
means of the common drinking cup at the 
school. To prevent this each child should pro- 
vide a cup or glass, which should be kept in 
the desk and be used by no one else. It must 
be cleaned and sterilized by boiling at frequent 
intervals. Under no circumstances should a 
glass or cup be dipped into the water ; it should 
be filled from a spigot. Where there is sufficient 
running water piped into the building, a bub- 
bling fountain is the most sanitary method of 
supplying drinking water, and, where installed, 
the individual drinking glasses or cups may be 
dispensed with. 

51 



Rural Hygiene 

DISPOSAL OF EXCRETA 

The disposal of excreta of the pupils is a 
matter of great importance. The general prin- 
ciples are the same as for disposal elsewhere, 
and in this section we will not go into the 
details which can be found under another 
heading. 

Where water is piped into the building the 
water carriage system, combined with the 
septic tank and sewage farm, should be used. 
This will be impossible in many of the schools, 
and earth closets will have to be substituted. 
They should be provided with some automatic 
device for distributing the earth, similar to the 
one shown in Figure n. The closets are best 
located in a detached building which is con- 
nected with the school by a covered passage- 
way. Separate buildings are to be provided 
for boys and girls. The seats should be ar- 
ranged to accommodate all sizes of children, 
care being taken that they are not too high for 
the smallest pupils. In winter the building 
must be heated, and at all times it must be 
kept clean. The teacher should make daily 
inspection to insure this. If neglected it will 
soon become filthy and, worse still, will be the 

52 



Schools 

depository for the vilest language imaginable. 
No scribbling on the walls should be allowed 
and loitering in or about the closet must be 
prevented. 

MEDICAL INSPECTION 

The school is the point of contact between the 
families of the district and it is often the distrib- 
uting point for many of the contagious diseases. 
Medical inspection is a new feature which has 
been introduced into many schools, and which 
should receive the hearty support of all who are 
interested in the health and education of chil- 
dren. In Massachusetts, in 1906, 432,937 
children were examined and 27,342 were found 
diseased, and this does not include those with 
defective eyes or ears. 

The following table, taken from a paper on 
school hygiene by G. A. Martin, shows the 
result of the examinations made in Massachu- 
setts in 1906. 

Diphtheria 238 

Scarlet fever 313 

Measles 637 

Whooping-cough 973 

Mumps 267 

Chicken-pox 548 

Influenza 276 

53 



Rural Hygiene 

Syphilis 36 

Tuberculosis 115 

Erysipelas 17 

Adenoids 2525 

Other diseases of the oral and respiratory tract. . . 5103 

Otitis (inflammation of the ear) 407 

Other diseases of the ear 363 

Conjunctivitis 779 

Other diseases of the eye 2 1 59 

Scabies and pediculosis 8745 

Skin diseases 3453 

Nervous diseases 146 

Deformities 142 

Total 27,342 

Although many of the cases in the table prob- 
ably were found in the schools of the crowded 
sections of the cities, the number from the rural 
schools are sufficiently large to warrant careful 
inspection in order to detect them. 

Vaccination is now required in most of the 
States before a child can enter the public 
schools. In some instances this regulation is not 
strictly enforced. This is so important that 
each child should be required to present a cer- 
tificate from a physician, showing the date of 
the last successful vaccination, before being 
entered in the school. Those who cannot 
produce such a certificate should be vaccinated 
at once or refused admission. Re vaccination is 

54 



Schools 

of such great importance that it would be wise 
to make regulations requiring revaccination 
before the child enters the grammar or the 
high school. This matter is more fully dis- 
cussed under smallpox. 

Recent examination of over four hundred 
thousand children in Massachusetts showed 
that 22.7 per cent, had defects of vision and 
that 6.3 per cent, had imperfect hearing. The 
difference between the city of Boston and the 
rest of the State was slightly in favor of the 
latter. 

There is no doubt that many of the defects 
of vision are caused or exaggerated by improper 
lighting of the school rooms, copying from 
blackboards, and night study in poorly lighted 
rooms. The light should come over the left 
shoulder. Night study should be prohibited 
except in the high school, and then only a 
very limited amount should be allowed. The 
teacher should not be required to spend her 
evenings in correcting papers. She works hard 
enough during the day, and every moment 
after school closes she requires for relaxation 
and sleep. 

The teeth of school children should receive 
55 



Rural Hygiene 

the attention of the medical inspectors. The 
examination of fifteen hundred children by a 
dental surgeon in Massachusetts showed that 
about one -third had bad teeth. In examining 
recruits for the army I have been struck by 
the large number of young men having bad 
teeth. It is rare to find one with perfect teeth, 
while the number who have bad teeth extracted 
is very large. A defective tooth eventually 
causes great suffering and the loss of many 
teeth will surely be followed by ill health. 
Among certain classes visits to the dental sur- 
geon are rarely made unless the person suffers 
from "toothache," and many children are not 
aware that they have defective teeth until 
these are damaged beyond repair. The regular 
inspection of the teeth of school children will 
certainly result in a great reduction in the 
number of teeth that have to be extracted. 

BACKWARD CHILDREN 

It is now known that many of the backward 
children have physical defects which can be 
relieved by simple means. Defects of vision 
and hearing and adenoids in the nose (making 
the child a mouth-breather) are the most 

56 



Schools 

common. These can usually be remedied by 
proper treatment and, where this has been 
given, the child has improved in its classes. 

INSTRUCTION 

What shall be the nature of the instruction 
in the primary schools has been much dis- 
cussed and is apparently not settled. Most of 
the schools in this country so arrange their 
instruction as to bring the pupil to the doors of 
the college at an early age. As a matter of 
fact hardly 2 per cent, of the children ever 
enter college, and 94 per cent, leave before 
entering the high school. It would therefore 
seem that the course should be arranged on 
some other basis. What seems a more satisfac- 
tory arrangement would be to introduce into the 
instruction more that will be of practical im- 
portance to the pupil during the working years 
of life. In the rural schools instruction in 
scientific agriculture with an agricultural high 
school at the end of the graded schools would 
seem to better meet the requirements of the 
community. The subject of economics should 
also receive attention, and the mechanical pur- 
suits must not be neglected. Instruction in 

57 



Rural Hygiene 

hygiene should be given to all during the school 
course. In the lower grades the teaching should 
be by example, the teacher explaining in very 
simple language why this should be done and 
that not done. In the higher grades a text- 
book should be used. Most of those now in use 
are largely devoted to physiology and anatomy 
and contain very little hygiene. We can get 
along very well with very little knowledge 
of anatomy or physiology but not without a 
pretty good knowledge of hygiene. The teach- 
ing of hygiene in the schools is of importance, 
not only to the individual but also to the nation. 
A very little knowledge of hygiene would have 
prevented the terrible epidemic of typhoid 
which prevailed in our army in 1898. 

Children should come to school with their 
hands and faces washed, and otherwise neat 
and tidy, yet it does not seem advisable to 
send a dirty child home the first time it comes 
to school in this condition. A child's self- 
respect is easily injured and it would be better 
to send a note to the mother at the close of the 
school. This note could be so worded as to 
make the mother see that it is to the child's 
advantage to be clean. A second warning 

58 



Schools 

should be given by the truant officer, who should 
explain the matter to the parents. After this 
the child should be sent home to be cleansed 
and be no longer allowed to come to the 
school in an untidy condition. 

It is important to prevent children from 
learning bad habits in the early days of their 
education, and the Massachusetts Association 
of Boards of Health recommends that they be 
taught the following : not to spit, especially 
on the slate or the sidewalk; not to put the 
fingers in the mouth ; not to pick the nose ; not 
to wet the finger with saliva in turning the 
leaves of a book; not to put pencils into the 
mouth or moisten them between the lips ; not 
to put money or pins into the mouth; not to 
put anything into the mouth except food and 
drink and the toothbrush; not to exchange 
apple cores, candy, or chewing gum. 

The nature studies are of importance as they 
create a desire for healthful amusement in the 
open air, something our people need to culti- 
vate as much as possible. In some cases the 
modern teacher has carried this to the point 
of ridicule and made it rather a burden than a 
pleasure. The aim should be to cultivate obser- 

59 



Rural Hygiene 

vation and a love of animals and flowers rather 
than to furnish the child with a great number 
of facts regarding which he cares little or noth- 
ing. Towards the end of the school year when 
the days are hot and the schoolhouse is far from 
comfortable, the time can be profitably spent 
in giving instruction in the fields, reviewing or 
elaborating the studies of the previous winter. 

WHEN TO SEND THE CHILD TO SCHOOL 

In determining when to send the child to 
school we are governed by age rather than by 
the growth and development, the proper guides 
in this matter. Many children begin as early 
as five years of age, but if the age limit is to be 
the standard it should be put at seven. A 
large number of children who are sent to school 
too early overtax their brains and become tired 
out long before they reach the upper grades. 
We educate the mind at the expense of the 
child's health in a great many cases. Notice a 
little boy of seven, a sad little fellow, with all 
marks of a delicate constitution who has begun 
school. He has to be up at six each morning 
and leave home at seven-thirty. He attends 
one of the public schools but has no place to go 

60 



Schools 

during the noon recess, so sits in the school- 
room. After his day's work he reaches home 
after dark during the winter months, and fre- 
quently says he is just a little tired. 

During the first month of school he contracts 
diphtheria, and before the year is over will have 
had any other disease that comes his way; 
perhaps he contracts tuberculosis. He should 
be at home where he can run about and get the 
fresh air. If educated he must be, his mother 
and father, who have time for their social 
duties, should teach him for a few hours a day. 

Young children should be confined to school 
but a very short time, three hours daily at the 
most. This time should be broken by an inter- 
mission of fifteen minutes, when, weather per- 
mitting, all the pupils should go out. At the 
end of each hour it is advisable to have the 
children march two or three times around the 
room. This prevents them from getting 
cramped in the position occupied at the desk. 



IV. 

WATER 



Water is of the greatest importance to the 
human race. It comprises about 70 per cent, 
of the body, and for drinking and cooking alone 
each of us uses about six and a half pints per 
day, while to provide for baths and other 
domestic purposes not less than sixteen gallons 
are required. A modern city needs, for all pur- 
poses, not less than one hundred and twenty- 
five gallons per person. 

Water for domestic uses must be clear, pure, 
abundant, and conveniently placed. Of these, 
purity is of the greatest importance. Not only 
must water be free from impurities which can 
be detected by the eye, the smell, or taste, but 
it must contain neither chemical, animal, or 
vegetable impurities which are injurious to the 
health of those who use it. 

The purest natural water is that which falls 
from the clouds in the form of rain or snow. 
At the moment a rain- or snow-drop forms it 

62 



Water 

is very pure, but as it descends to the earth it 
collects a considerable quantity of impurities. 
Whether these are injurious or not depends 
upon the condition of the air through which it 
falls. In the vicinity of our manufacturing 
cities it would be very impure, while on the 
western plains or on the tops of high mountains 
the impurities are not of a serious nature. 

A considerable portion of the rainfall runs 
directly into the rivers or other water courses, 
carrying with it all manner of impurities. A 
smaller portion is absorbed into the earth, 
where it remains as ground water or appears 
at some distant point as a spring. In its pas- 
sage through the soil, it absorbs mineral and 
other substances, some of which are highly 
undesirable, but most of them are in no way 
detrimental. The most dangerous water is 
that which contains animal or human excre- 
ment. With the increase in the density of 
population in this country there has been a 
steady decrease in the purity of our waters, 
until, at present, there is very little really pure 
water. In Vermont the examination of 231 
samples of water from wells, springs, and 
ponds showed that 22 per cent, of the springs, 

63 



Rural Hygiene 

50 per cent, of the wells, and 41 per cent, of 
the ponds were impure or of doubtful purity. 
The importance of pure water to a community 
is shown by the following table taken from the 
Monthly Bulletin of the New York State De- 
partment of Health for April, 1908. The table 
shows the average death-rate per 100,000 from 
typhoid fever for cities in New York over a 
period prior to the improvement in the water 
supply, the average typhoid death-rate per 
100,000 since the change in the water supply, 
and the percentage of reduction caused by the 
improvement. 

Average Average Percentage 
before after reduction 
improve- improve- in death- 
Place ment ment rate 



Albany 88 

Binghamton 39 

Elmira 54 

Hornell 42 

Hudson 64 

Ithaca 67 

Rensselaer 95 

Schenectady 25 

Troy 58 

Watertown 94 



« 23.7 73.0 

3 11. 7 72.2 

9 41.5 24.4 

2 24.7 41.4 

3 3 x -9 50-5 
2 14.6 78.3 

5 54-4 43 -o 

o 14-4 42.6 

2 31.0 46.8 

7 36.9 61.8 



Water for domestic use in the rural districts 
is generally derived from the following sources : 
wells (shallow dug wells), springs, rain water, 
rivers, lakes, ponds, or artesian wells. 

64 



3* 




Water 

WELLS 

The most common source is the well. This 
ordinarily is badly situated and is almost 
always polluted. 

The usual country residence is located on a 
slight elevation, the barn and other out-houses 
being placed as near as possible. In order to 
save digging, the well is not infrequently placed 
at a much lower level than the privy or the 
stable and receives the drainage from both. 
In not a few cases it is located in the barn-yard. 
It is rare to find one that is curbed or with a 
tight-fitting cover. Pumps are not used as often 
as they should be. The old-fashioned well 
sweep is very picturesque and the "Old Oaken 
Bucket" sounds very well in the poem, but to 
have this the well must be open and be a 
collecting place for all the filth that blows, and, 
not infrequently, for the washings from irre- 
sponsible persons who may use the well. In 
India the well-bucket is a fruitful source of 
the dissemination of cholera, and what is true 
of cholera is generally true of typhoid fever. 
Without doubt there are many wells in this 
country that are infected with typhoid fever 
through the same medium. 
5 65 



Rural Hygiene 

The purity of the water in the well also de- 
pends upon the geological formation in which it 
is located. 




Fig. 4. — Showing relation of purity of water in well to the geological 
formation. 

Ground water, which is the source of the 
water in the well, is found in the sand or the 
gravel which overlies clay or impervious stone. 

66 



Water 

Where the impervious strata are horizontal and 
the water is drawn from a layer of water- 
bearing gravel or sand that is separated from 
the surface by a layer of impervious material, 
the water will generally be pure. If there be 
no such layer between the water and the sur- 
face , its purity depends upon the condition of 
the ground about the well. If the strata be 
tilted on end, the character of the water will 
depend upon the location of the well with 
regard to the source of possible contamina- 
tion. This is shown in the illustration. The 
tilt of the strata is such that the seepage 
from "A" will not contaminate the well, but 
anything thrown into "B" will eventually find 
its way into it. 

Wells which are sunk into limestone forma- 
tions are to be looked upon as suspicious. 
They are not infrequently fed from underground 
reservoirs that draw their water directly from 
polluted sources through the rifts and crevices 
which abound in such regions. 

A good well is one that is sunk into a water- 
bearing stratum that is separated from the sur- 
face by an impervious layer of clay, slate, or 
similar material. It is to be curbed, lined with 

67 



Rural Hygiene 

cement from top to bottom, and provided 
with a tight fitting cover that has sufficient 
pitch to throw off all rain-water. The cover 
must be kept locked at all times, and the water 
should be drawn through a pump, located 
several feet away and provided with a gutter 
through which the waste water will run off. 
The curb should extend several feet above the 
grade, and the ground around the well should 
slope away from it and be covered with cement 
or with well-rammed clay. A fence had better 
be built to exclude chickens and other animals, 
and the watering trough for the cattle should 
be placed at a distance and, if possible, much 
lower down than the well. In some localities 
the well is lined with boards, but this is objec- 
tionable as they soon rot and always harbor 
rats and insects. 

There are places where, for many reasons, it 
is impossible to obtain water from other than 
polluted wells. In such a case the natural 
question is, what can be done to improve the 
water supply and render it reasonably safe? 
The answer should be, boil or otherwise sterilize 
the water. Doctor Koch has suggested the fol- 
lowing method of improving the well: Thor- 

68 




Fig. 5. — A well in the suburbs of Washington from which a 
large number of persons draw their drinking water. It receives the 
surface drainage from the track of a branch of the B. & 0. Railroad. 



Water 

oughly clean it out and as far as possible empty- 
it of water. Next fill it with clean sand to with- 
in two feet of the lowest water-level. A large 
iron pipe with an expanded end is now passed 
down until it rests upon the sand. The space 
around the pipe is now filled to the water-level 
with gravel and the remainder of the well is 
filled with clean sand. A smaller iron pipe is 
now passed down the large pipe into the water 
and a pump attached. This is in reality a 
sand filter and usually furnishes pure water, 
but is not always reliable. A somewhat similar 
method is to use a Norton tube, which con- 
sists of a large iron pipe pointed and perforated 
at the end. This is driven into the water- 
bearing strata. 

In India suspicious wells have been rendered 
pure by the following method: Dissolve two 
ounces of permanganate of potash in a bucket 
of water and lower it into the well. If after an 
hour the water from the well has a delicate pink 
color it is fit for drinking, but, on the other 
hand, if it be clear, the procedure must be 
repeated until a delicate pink color is obtained. 
This is not a very safe method of purifying, as 
the polluted water is continually entering and 

69 



Rural Hygiene 

will sooner or later use up all the chemical and 
then the water will be as impure as before. 

SPRINGS 

Springs are very commonly used for domestic 
supply, especially in hilly or mountainous 
country. The water, as it issues from the 
ground, is generally pure; but very often it is 
infected from the washings of the surrounding 
ground, or from dirty vessels which are dipped 
into it. The purity of the spring depends upon 
the source of the flow and upon the surround- 
ings. Instances are on record where large 
springs have communicated directly with pol- 
luted marshes on the other side of a mountain. 

The appearance of the water is no guarantee 
of its purity, for not infrequently the most 
sparkling waters contain impurities of an animal 
nature very injurious to man. The surround- 
ings of the spring must be under constant 
inspection lest some privy or cesspool be located 
over the channel through which it receives its 
water. Only recently I inspected a spring that 
had a local reputation for purity and found a 
most filthy yard and privy located not a hun- 
dred yards up the hill. 

70 



Water 

A properly protected spring should have a 
curb on all sides and a cover. The curbing 
should be cement lined and extend several feet 
above the surface of the ground. A pipe should 
pass through the wall and carry the water 
several feet from the spring and be at such a 
height that a bucket can be placed beneath it. 
Springs that are walled up on three sides and 
are approached on the fourth by a flight of 
steps are no doubt very picturesque but they 
are most dangerous as they are liable to become 
polluted by filth carried on the feet of those 
who draw water. 

RAIN-WATER 

From the earliest times rain-water has been 
recognized as pure. This is probably the 
safest supply for rural districts, provided the 
rainfall is sufficient. In making estimates for 
the storage of rain-water we must consider not 
only the annual fall of rain and snow, but also 
its distribution throughout the year. Fairly 
exact data upon this subject can be obtained 
from the Chief of the Weather Bureau in 
Washington. The following table shows the 
quantity of water that will be collected per 
square foot, for different depths of rainfall. 

71 



Rural Hygiene 

Rainfall in inches per Yield in gallons per 

square inch of surface square foot of roof 

.01 .006 

.10 .060 

I. OO .600 

2.00 I.200 

A less accurate method of arriving at the 
probable yield of the roof is to multiply the 
area of the roof, without regard to slope, by 
half the average rainfall. The result will be 
the probable number of gallons the roof will 
yield. The error in this calculation will amount 
to about 20 per cent. In all calculations of 
the area of the roof the slope is not considered. 

The cistern in which the water is to be stored 
may be made of iron, wood, or, as is usual, of 
stone. If of the latter the walls must be at 
least eight inches thick and covered on the 
inside with cement. The bottom is to be of 
brick laid in cement, and the inside divided 
into two compartments by a wall, the com- 
munication being through an opening in the 
lower portion. One compartment communi- 
cates with the roof, the other with the delivery 
pipes. The bottom of each compartment is 
filled with layers of clean sand, coke, and gravel 
for the purpose of filtering the water, the gravel 
being on the bottom and the sand on top. 

72 



Water 

Such a filter, if properly managed, will remove 
all the suspended dirt and the germs from the 
water. A gate must be introduced into the 
pipe leading from the roof to the cistern so that 
the first portion of the water, which contains 
the washings from the roof, may be excluded. 
The overflow pipe must not connect with a 
sewer or with a cesspool. 

We have so far only considered the cistern 
which is located beneath the ground, this being 
the usual location. The disadvantages of such 
a position are many and the only advantage is 
that it furnishes cooler water. It is at all 
times liable to have cracks in the wall and 
thereby become contaminated from the ground 
water or the cesspool or privy. Trees are also 
liable to penetrate the walls with their roots. 
It is strongly advised to place the cistern above 
ground. At times it is more desirable to place 
it in the garret. In such a case a wooden or iron 
one is used, and in making calculations it is 
to be remembered that a gallon of water weighs 
10 pounds, otherwise the load may be too 
great for the floor. A cistern located in an 
upper floor allows of modern water fixtures and 
running water throughout the house. This is 

73 



Rural Hygiene 

very desirable, but a greater quantity of water 
must be provided for. 

Results just as good can be had by pumping 
the water to a tank in the garret or to a level 
higher than the floor in which it is to be used. 
This may be done by a windmill, but some idea 
of the velocity of the wind must be obtained 
before it is installed or it may not be sufficient 
for the task. The number and duration of 
calms should be known also. These data can 
be obtained from the Chief of the Weather 
Bureau. 

Hydraulic rams are cheap and require little 
attention. They will work even if the water 
head is as little as eighteen inches. They may 
be substituted for the windmill. 

One of the most satisfactory methods of 
elevating water is by the pneumatic tank. 
This consists of air-tight steel tank into which 
water is pumped. This compresses the air in the 
tank and when the pressure becomes sufficient 
it will force the water to a higher level. Fifteen 
pounds pressure to the square inch will force 
the water to a height of thirty-three feet. A 
pressure of ten pounds will elevate the water 
twenty-two feet. The pumping may be done 

74 



Water 

by hand, by a windmill, hydraulic ram, or 
small engine, depending upon the forces avail- 
able and the financial condition of the house- 
holder. 

The advantages of this system are that the 
water can be supplied to all portions of the house 
at a low cost and without placing too great a 
load upon it. The tank may be placed in the 
cellar or under the ground. 

The quantity of water to be stored depends 
upon the conditions under which it is to be 
used and the size of the family. Twelve gal- 
lons per person is what is generally required for 
domestic purposes, but where baths are inclu- 
ded the quantity should not be less than sixteen 
gallons per person per day. Where water- 
closets are used twenty-five gallons will be 
required. Each cow and horse will use from 
six to ten gallons per day. Allowing twenty- 
five gallons per person for a family of five, 
provision will have to be made for the storage 
of 3750 gallons per month. The length of time 
the water will have to be stored depends upon 
the distribution of the rainfall. Where the 
number of rainy days and the fall per day is 
evenly distributed throughout the year the 

75 



Rural Hygiene 

time will be much less than where there is a 
well-marked dry season. 




Fig. 6. — Sketch of cistern and filter. There is an open arch in 
the central wall through which the water after filtering through the sand, 
coke, and gravel enters the side connected with the pump and ascends 
through layers of gravel, coke, and sand. 

The above sketch shows the manner of con- 
structing a cistern and filter. 

76 



Water 

ARTESIAN WELLS 

These are drilled into the ground until they 
penetrate a stream of water under sufficient 
pressure to force it to the surface. They 
usually furnish pure water but much depends 
upon the geological formation of the country. 
In limestone regions one is liable to tap waters 
that come from polluted sources without the 
nitration which usually takes place as water 
passes through the soil. It is well to consult a 
geologist before beginning such a well, for 
there are many formations from which it is 
impossible to obtain water. The depth of the 
well is no indication of its purity. In the city 
of Washington, where the dug wells are always 
polluted, artesian wells which are but one 
hundred feet deep furnish pure water. 

These wells are recommended where it is 
possible to have them at a cost that is not 
greater than pure water from some other sources. 

SURFACE WATERS 

A considerable proportion of our people 
obtain their water from rivers, lakes, and ponds. 
In America few of these can be considered pure, 
and it is wise to consider them all as polluted 

77 



Rural Hygiene 

unless their purity has been established by 
careful chemical and bacteriological examina- 
tion and by a careful inspection of the water- 
shed from which the water comes. 

We have been most careless of our streams. 
As arteries of commerce we have long recog- 
nized their value and have spent large sums to 
keep them navigable, but to assure their purity 
practically nothing has been spent. But a 
few years have passed since the Federal Gov- 
ernment allowed the city of Chicago to change 
the course of a small stream and by digging an 
extensive canal to dump her refuse almost into 
the water-mains of a rival city. Learned 
judges and scientists have considered this 
matter and allowed it, and yet the fact remains 
that the Mississippi is being polluted by the 
sewage from Chicago and that the dwellers on 
the banks of the canal are in danger of con- 
tracting typhoid fever and other diseases from 
what Chicago calls a great improvement. 
Reports from Chicago would lead us to believe 
that there is no danger to the dwellers on the 
banks of the canal, and yet recent studies made 
in the city of New York have shown that it is 
not safe for a community to dump its unpuri- 

78 




Fig. 7. — The babbling brook. Cool and inviting the wayfarer 
to quench his thirst. This stream receives the drainage from a num- 
ber of privies and manure piles but a short distance above this point. 




Fig. 8. — Railroad crossing Cochituate Lake from which comes 
part of the water supply of Boston. The drainage from the tracks is 
directly into the lake. 



Water 

fied sewage into neighboring watercourses. 
D. D. Jackson, working for the Merchant's 
Association, found that there is a belt of the 
city in the vicinity of the openings of the 
sewers where typhoid fever is especially preva- 
lent. He trapped flies in this area and found 
that they carried the germs on their bodies. 
That flies are one of the most usual ways of 
spreading typhoid fever is no longer doubted. 
The dumping of sewage into running water, 
or any water for that matter, is not only a 
danger to the health of the community but also 
a direct loss to the community. The refuse 
from' our bodies represents fertilizer, which, if 
applied to the land in a scientific manner, 
would make many of the abandoned farms rich. 
This can be done without great expense and 
without danger to the community, and it is 
time the rural voters, who hold the power in 
the affairs of this country, should insist on 
legislation that will prevent the cities from 
polluting the waters of the rivers which flow 
past their homes. That this may not seem an 
idle dream I may say that the health officer of 
the Philippine Islands tells me that not one 
drop of polluted water from the sewers of 

79 



Rural Hygiene 

Manila is emptied into any watercourse until 
it has been purified. 

Water from rivers, lakes, and ponds is usu- 
ally stored in reservoirs before being used. It 
has been proven that water stored in such places 
tends to purify itself if allowed to stand for 
sufficient time. It is rarely possible to keep 
water long enough to accomplish this, but its 
quality is decidedly better for even a short 
storage. Reservoirs are not practicable for 
small communities because of their cost, but 
by combining resources the inhabitants of a 
thickly populated district should be able to 
provide such a system. The communities in 
the vicinity of Boston are supplied in this way. 

Before work is begun on a reservoir it is 
necessary to have the entire question gone over 
by a competent engineer, who should study the 
drainage area from which the supply is to come 
and also the character of the water. In many 
instances pure water will not be obtained with- 
out the use of a filter bed. This latter fur- 
nishes the best water in the world. 

Not infrequently scum of different colors 
forms on water that is stored in reservoirs, 
and at times it forms in the pipes and closes 

80 



Water 

them entirely. This is caused by a minute 
plant which generally does no harm, but in 
some instances imparts an unpleasant odor to 
the water. There are reasons to believe that 
the use of such water for drinking may cause or 
aggravate diseases of the stomach or intestines, 
especially in young children. This growth may 
be gotten rid of by dissolving in water sufficient 
sulphate of copper (bluestone) to make a solu- 
tion of the strength of one part of the copper 
to four million parts of water, or about one 
grain to sixty gallons. In practice this may be 
accomplished by placing several pounds of the 
bluestone in a sack and drawing it over the 
surface of the water. The quantity of copper is 
so small that there is no danger of poisoning. 

Many communities and private individuals 
are obtaining impure water from ponds or 
rivers, when by extending the intake pipe 
further from the shore a much better water 
could be obtained. In general, drinking water 
should be taken from a point where there is a 
swift current, and eddies should be avoided. 

In regions where irrigation is practiced there 
is more typhoid fever than in similar sections 
where there is no irrigation. This is without 
6 81 



Rural Hygiene 

doubt due to the rather common practice of 
drinking from the ditches. Irrigation also 
raises the level of the ground water to such a 
height that it is more readily contaminated, 
thus rendering the water from wells in such 
regions less pure. 

There is little doubt that the tramps and 
other vagabonds who wander about the coun- 
try, spending the night wherever darkness 
overtakes them, not infrequently contaminate 
the water supply. They are liable to relieve 
themselves upon the banks of the reservoir and 
many of them must at some time or other be 
infected with typhoid. Camps of workmen and 
soldiers are also a danger, and the community, 
through its health authorities, should see that 
this danger is reduced to the lowest possible 
terms. Each community has a right to protect 
itself and each should see that any campers 
who come into the neighborhood observe proper 
precautions regarding the disposal of their 
excreta and refuse. A recent epidemic of 
typhoid fever in Poughkeepsie, N. Y., was 
traced to a camp of workmen on the water-shed 
of the reservoir from which the town was sup- 
plied. In 1 903 there was an epidemic of typhoid 

82 



Water 

fever in Ithaca, N. Y., about 10 per cent, of 
the people were attacked and it cost the citizens 
of the town about two dollars each to suppress 
it. The New York Department of Health 
believes that this epidemic was started from a 
case which occurred in a camp of laborers 
stationed on the bank of one of the streams from 
which the city obtained its water. 

Our military camps in 1898 spread much 
typhoid among the civilian population in their 
vicinity. 

The present method of disposal of the excreta 
from our railroad trains is a constant danger to 
the community. One can very readily imagine 
a person in the early stages of typhoid fever or 
one with cholera using the closet and scatter- 
ing the germs along the track for miles. Prob- 
ably some of the excrement will find its way 
into a water supply. The railroads should be 
made to adopt some better and safer method 
of disposal. 

WATER FOR ANIMALS 

Pure water is also a necessity for cattle and 
other domestic animals. It has been proven 
that hog cholera can be disseminated by im- 
pure water. The following diseases of animals 

83 



Rural Hygiene 

are said to be transmitted through the agency 
of impure water: twisted stomach worm, 
nodular disease, paper skin, liver flukes, lung 
worms in sheep, and worms in horses, hogs, 
and cattle. 

SIMPLE TESTS FOR PURE WATER 

There are a few simple tests which give some 
idea of the quality of water. 

One of the simplest is to partially fill a bottle 
with water that has a temperature of from 
7o°-8o° and shake it vigorously for several 
minutes. If on removing the cork there is an 
unpleasant odor, the water is to be condemned. 

A more reliable test is to make a solution of 
one part of permanganate of potash to one 
thousand parts of water and place a few drops 
of the solution in the water to be tested. If 
the water remains pinkish, it is free from 
organic matter, but if, on the other hand, the 
color entirely disappears, the water is to be 
condemned. 

These tests are only rough and are intended 
to be used in emergencies. It is now possible 
in almost every State to have the water ex- 
amined by the State Board of Health. 

84 



Water 

PURIFICATION OF WATER 

The most satisfactory way to purify a water 
is to pass it through a sand filter. These 
niters are costly and the individual who has 
to use a suspicious water must adopt some other 
method. The domestic filters, of which there 
are a large number on the market, are very 
satisfactory in the laboratory but in actual 
use they are not to be relied upon. The most 
satisfactory way to purify water for domestic 
purposes is to heat it to 212 (boiling point of 
water). This can be accomplished by boiling 
for twenty minutes (not heating but actually 
bubbling). The Forbes sterilizer is a machine 
which boils water at the lowest possible cost 
with practically complete destruction of all 
germs. The following description is furnished 
by the manufacturers : 

PRINCIPLE OF OPERATION OF THE FORBES WATER 
STERILIZER 

The workings of the sterilizer are shown in 
the following diagram : 1 shows a water tank 
with a pipe (2) through which the raw or 
unsterilized water enters and is allowed to fill 
the tank up to the level x, but no higher, as 
it is restrained by the float-actuated valve 

85 



Rural Hygiene 

shown in the tank. Should the water for any 
cause whatsoever, rise above the level x, the 
excess will flow off through the waste pipe 3. 
Starting from the water tank 1, in which the 
water has a fixed level, the raw water flows 




Fig. 9. — Forbes water sterilizer, from a cut furnished by the Forbes 
Company. (From Brewer's "Personal Hygiene in Tropical and Sub- 
tropical Countries.") 

down through pipe 4, then up through com- 
partment 5 into the heater 6, and up the tube 
7 until it reaches the level x. Above this it is 
impossible for the water to go under natural 
conditions. 

The burner 8 is now lighted and heat is ap- 
plied under the heater 6, which causes the water 

86 



Water 

in the heater to boil and in boiling to rise in 
the tube 7 and overflow into cup 9. It is im- 
possible for any raw water to pass from 7 to 
9. The water is boiled for a fraction of a second, 
and once the water has passed through the tube 
7 it is removed from where heat can reach it. ' 

When the water has boiled over as stated 
above, the level in the heater 6 and in the tank 
1 is lowered, and more raw water flows in, 
filling the tank to the level x. 

The water continues to boil over into cup 9, 
quickly filling compartment 10, where it loses 
its heat to the cold water on the other side of 
the thin metal partition 11. When 10 is filled 
the water rises up in the pipe 1 2 and flows away 
through the pipe 13. 

The manufacturers claim that the water 
discharged through 13 is but three degrees 
warmer than the water that is supplied to 
tank 1. 

Where kerosene oil costs eight cents per 
gallon one hundred quarts of water can be 
sterilized for one cent. 

Water that has been sterilized by heat must 
be cooled, but it is not wise to place ice in it. 
Even though the ice be made from distilled 

87 



Rural Hygiene 

water it is more than likely that it has been 
polluted before it reaches your box. By plac- 
ing the water in bottles on the ice, it will be 
cooled sufficiently to make it suitable for drink- 
ing. Water that contains ice is too cold and 
not healthful. 

SUMMARY 

We may summarize what has been said 
in the previous pages about water as follows: 

Use cisterns where the rainfall is sufficient. 

Use artesian wells when possible. 

Use springs if from deep sources, when prop- 
erly protected and when they have been shown 
to be pure by official tests. 

Use river, lake, or pond water when it has 
been passed through a filter bed or when it 
comes from a sparsely inhabited area and has 
been shown to be pure by official test. 

The well is to be condemned. 

In all cases where there is uncertainty as to 
the purity of the water boil it or otherwise 
sterilize it. 



V. 

DISPOSAL OF EXCRETA 



The .disposal of excreta of the human race 
has been a question before the public since the 
Jewish exodus from Egypt. At that time 
Moses, the great sanitarian of the Children of 
Israel, instructed them to void their excrement 
without the camp and to cover it with earth. 
Under the same conditions, at the beginning 
of the twentieth century, we can find no better 
system for a nomadic people. 

True economy demands that all the excreta 
from man and animals, both liquid and solid, 
should as soon as possible be returned to the 
soil to replace the nitrogen and other elements 
abstracted therefrom by the growing vegeta- 
tion. The Chinese and the Japanese have long 
recognized this and have developed their 
methods of disposal so that none of these 
valuable fertilizers are lost. In our country the 
reverse is the case. At great expense our people 
construct sewers which dump their refuse into 

89 



Rural Hygiene 

the nearest watercourse, thereby losing its value 
as fertilizer and at the same time polluting the 
waters, turning the bays, rivers, lakes, and 
ponds, which should be for the refreshing and 
recreation of the people, into huge cesspools. 
This pernicious system has grown year by 
year until nearly all of our waters are polluted. 
The sanitarians have apparently been satisfied 
with this method until the last few years, when 
we have occasionally heard a word against it. 
During the past year the Merchant's Associa- 
tion of the city of New York began to look into 
the matter. As a result of their study of the 
conditions that obtain in New York Bay, it has 
been learned that the practice of discharging 
sewage into rivers is not only dangerous to 
those living further down the stream, but that 
the city itself suffers from the pollution. Their 
expert found areas around the mouths of the 
metropolitan sewers where typhoid fever was 
very prevalent. Further investigation showed 
that the shores and the piling under the docks 
near the mouths of the sewers were covered 
with excrement, and that flies caught in such 
localities swarmed with germs derived from 
the human intestines. 

90 



Disposal of Excreta 

The Hudson River, which we look upon as 
picturesque and attractive, is in reality a great 
sewer, carrying the excrement of over 210,000 
persons, and one part in every three hundred 
parts of water is derived from the sewers which 
empty into it. Many of the smaller streams in 
the country are as bad and some are much worse. 

In the endeavor to solve the problem of the 
proper disposal of the excreta from human 
beings we must aim to conserve as much of it 
as a fertilizer as possible, and at the same time 
the health of the community must be guarded 
with greatest care. The method of disposal 
must vary with the local conditions, and it is 
therefore impossible to recommend any one 
system which will answer for all cases. We 
shall therefore in this section discuss the 
methods usually employed, endeavoring to 
point out their good and bad features, con- 
demning those which are unsanitary, and 
leaving to the individual the choice of the one 
which is most suited to- the needs of his par- 
ticular locality. The following will be con- 
sidered: privies, cesspools, water carriage 
system, sewage farming, Waring 's system, 
septic tanks, dry earth system, pail system. 

91 



Rural Hygiene 

Savage races have no fixed place for voiding 
their faeces; each individual chooses the place 
most to his convenience and passes his faeces 
on the ground regardless of the rest of the com- 
munity. Where the inhabitants are widely 
scattered this causes but little nuisance, but 
there is always danger of polluting the water 
and infecting food through the medium of flies. 

PRIVIES 

The privy is the first improvement that 
makes its appearance as man becomes civil- 
ized. Every one is more or less familiar with 
it. It is to be condemned from every point of 
view. It is offensive from the odor, it is the 
breeding place for millions of flies, and a source 
from which the wells and cisterns become pol- 
luted. Particularly dangerous is the privy 
which is placed over running water or an aban- 
doned well, especially the latter, as the connec- 
tion with the water supplying the other wells is 
direct. The flies which breed in the privy will 
sooner or later find their way into the dining- 
room or kitchen, bringing on their feet any 
germs that may have been in the faeces. Should 
a person with typhoid fever, cholera, or dysen- 

92 



Disposal of Excreta 

tery use the privy, there would without doubt 
be cases among the inhabitants of the house. 

CESSPOOLS 

These are also condemned because they are 
very dangerous. Frequently they are but 
excavations in the ground, bricked up to pre- 
vent the sides from caving in; in other cases 
they are built of stone or brick and lined with 
cement. In the first class the liquids drain 
away and eventually find their way into the 
wells in the vicinity. In the latter case they 
have to be emptied at frequent intervals, which 
means soiling the ground in their vicinity and 
a most disagreeable odor. In many cases the 
walls become cracked and the fluids leak 
away, polluting both the ground and the water. 

WATER CARRIAGE 

This presupposes that there is running water 
and modern plumbing in the house, properly 
trapped and ventilated. These methods are 
too well understood to require repetition here. 
In this system the sewage leaves the house in 
pipes, being carried a longer or shorter distance 
and discharged into some running water, a 

93 



Rural Hygiene 

lake, or the sea. This method is neither to the 
advantage of the individual nor the public. 
By its use we have turned our rivers, lakes, 
and bays into great cesspools. From an eco- 
nomical point of view it is the means of im- 
poverishing the nation to the extent of thou- 
sands of tons of the most valuable fertilizer. 
The time is not far off when our people will 
have to recognize this and prohibit the waste. 

SEWAGE FARMING, WARING'S SYSTEM, 
AND SEPTIC TANKS 

These are considered together for they are 
now generally combined in all the modern 
sewage farms. 

Sewage farming, in some of its different 
forms, is the most satisfactory method of dis- 
posal of the excreta of human beings. It is the 
nearest approach to the ideal, both from the 
sanitary and from the economical standpoints. 

For its operation, running water must be 
introduced into the house and modern plumb- 
ing is required. An expert must make the 
installation and only reliable workmen should 
be employed. Work that is done by first- 
class workmen and of first-class materials will 

94 



Disposal of Excreta 



last a long time and the cost of repairs will be 
reduced to a minimum. 

The system that goes by the name of the 
late Colonel Waring was first used by the Rev. 
Mr. Moule but was extended and perfected 
by Colonel Waring. He conducted the drain 





znnsmii 



Fig. io. — Sewage disposal plant, septic tank, and irrigation plant. 

pipes into a reservoir provided with an auto- 
matic siphon by which it is emptied. From 
the reservoir the sewage is conducted by open 
joint pipes, placed ten inches below the ground, 
to a garden or field. To provide for an inter- 
mittent flow through the pipes, three sets are 
laid and the flow regulated by a gate, so that 

95 



Rural Hygiene 

the soil fed by each set of pipes can have at 
least twenty-four hours to dispose of the sew- 
age distributed to it. On either side of the 
pipes the ground is made into a garden or lawn 
and planted with grass or root crops. The 
success of the system depends upon the capacity 
of the soil to absorb moisture and upon the 
power of the bacteria of the soil to break up the 
organic matter in the sewage. A rich garden 
soil is the most suitable. Where there is plenty 
of land the pipes may be dispensed with and the 
sewage conducted through open trenches. The 
reservoir should provide storage for fifty-nine 
gallons per person, and in the best soils one 
hundred feet of piping is to be provided for 
each fifty gallons to be disposed of. 

The system works well in winter as the liquid 
is warm enough to keep from freezing and to 
melt frozen soil. 

Not all soils are suitable for irrigation and 
it is often advisable to combine the septic 
tank with the Waring system. In fact the 
septic tank is desirable in all cases unless the 
quantity of sew T age to be disposed of is very 
small. 

When this is used the water from the house 
96 



Disposal of Excreta 

passes into a large covered tank where the 
solids are deposited and slowly broken up. 
The liquids fill the tank and overflow into other 
tanks, finally passing into the flushing tank. 
The rest of the system is similar to that previ- 
ously described. In the tanks the organic 
matter and the germs of disease are destroyed 
by the bacteria which grow in the sewage. 

The cost of such a plant depends upon the 
price of the materials used. 

DRY EARTH SYSTEM 

If properly managed this is a most satis- 
factory system, from a sanitary as well as from 
an economical point of view. Unfortunately 
the management requires more attention to 
details than the ordinary person is willing to 
give to it. In cold weather the liquid portion 
of the excreta is liable to freeze, which seriously 
interferes with the working of the closet. It 
can, however, be managed even in a cold cli- 
mate so as to cause no nuisance and at the same 
time be perfectly convenient and sanitary. 
Doctor Bashore has used one for many years 
and has always found it satisfactory. 

This is one of the oldest methods of disposal 
7 97 



Rural Hygiene 

of which we have any record. As developed 
by modern sanitarians the excreta are passed 
into galvanized iron drawers or buckets which 
contain a few inches of dry earth, each person 
covering his stool as soon as passed. Some 
closets aim to have separate containers for 




Fig ii. — Self-acting peat-dust closet. The lid is replaced by a 
hinged reservoir containing the peat dust. Whenever this is let down a 
certain quantity of peat dust is discharged automatically and thrown 
upon the night soil. (From Weyl's Handbuch der Hygiene. II, p. 315.) 
(From Smith's "Sewage Disposal on the Farm," Farmer's Bulletin 43, 
United States Department of Agriculture.) 

liquids and solids, but this is not necessary 
provided there is sufficient earth placed in the 
drawer to absorb all the urine. 

The drawers must fit close up under the seat 
and be several inches larger than the hole. 
An automatic device, as shown in the cut, may 

98 



Disposal of Excreta 

be provided for distributing the earth, but this 
is not necessary if each person will at once cover 
his or her stool. The earth can be kept in boxes 
or buckets, a tin can with handle or grocer's 
scoop being provided for distributing it. 

The best substance for covering the stool is 
peat or loam from a well-cultivated garden. 
Clay, ashes, and sand are the least desirable. 
Whatever the substance used, it must be finely 
pulverized and very dry, but under no cir- 
cumstances should artificial heat be used since 
it kills the nitrifying germs of the soil upon 
which the efficiency of the system depends. 
For the same reason no disinfectant is to be 
used. 

It has been ascertained that about a pound 
of earth per person per day will be required to 
successfully operate the closet. This means 
nine hundred pounds per year for a family of 
five. The quantity sufficient for the needs of 
the house should be collected, dried, and stored 
during the dry season. Where peat can be 
had it should be used, provided the cost is not 
too great. 

The drawers should be emptied at least once 
daily, the contents being buried under not more 

99 



Rural Hygiene 

than ten inches of soil. Doctor Bashore has 
used a plot of ground twenty by sixteen feet 
for the past ten years, burying in it the faeces 
and kitchen refuse from a family of four with- 
out causing odor or in any way polluting the 
water supply. 

There should be duplicate drawers or buckets 
so that the soiled ones may be thoroughly 
washed and sunned before being used again. 

The system looks nice on paper but there are 
many disadvantages about it. The most im- 
portant is the inability to get all persons to 
cover their stools. The freezing of the urine 
can be obviated by placing the closet in a room 
that is heated. Did the system work auto- 
matically it would be ideal, but as it requires 
the co-operation of so many users, it generally 
fails. 

The disposal of urine is a matter of consider- 
able importance, especially where there are 
many workmen. In such places it is necessary 
to provide urinals apart from the closets used 
for the solid excreta. Doctor Poor has ap- 
parently solved this problem by filling a bag 
with six pounds of sawdust and having the 
urine parsed into it. In the course of two 

ioo 



Disposal of Excreta 

months thirty-nine pounds of urine were 
passed into the bag, which became very rotten 
but was free from odor and the liquid which 
filtered through it caused no nuisance. This 
sawdust could be buried in the garden and 
would be a valuable fertilizer, as urine contains 
a large amount of nitrogen. 

PAIL SYSTEM 

In this system the drawers of the dry earth 
closet are replaced by pails which are removed 
once or twice daily, dumped, and sunned, a 
clean pail being substituted for the soiled one. 
It is open to many of the objections of the dry 
earth closet and lacks some of its advantages. 

The pails are made of galvanized iron, zinc, 
or wood, and should be oval in shape. They 
are to be washed with milk of lime each time 
they are emptied. 

The contents of the pails are to be disposed 
of in the same manner as the excreta from the 
dry earth closet. 

This system does not seem to meet the 
requirements of our civilization. 

There is one danger to which the rural and 
the city dwellers are exposed, over which at 

101 



Rural Hygiene 

present they have no power. That is the 
contamination of the ground and the water 
supply by the excrement of persons travelling 
by train. To say the least the present method 
in use by railroads is most filthy, and when we 
consider that in many instances the tracks 
cross streams which feed reservoirs and that 
not a few trains pass through the streets of 
cities and villages, it can be readily seen how 
such practices may be the starting point of 
serious epidemics of typhoid or similar diseases. 
The rural voters hold the balance of power in 
this country and if they will insist upon it the 
corporations interested will be compelled to 
adopt a more sanitary method of disposal of 
the refuse and excreta from their trains. 

The disposal of the excreta from animals will 
be considered under the heading of manure. 



VI. 

FOOD AND DIET 



Food is anything which, when taken into 
the body directly or indirectly, builds up its 
structure, repairs waste, or produces energy in 
any form. 

In order to determine the value of foods 
students of the subject have established cer- 
tain standards of measurement which have for 
their basis the calorie or the amount of heat 
required to raise the temperature of one cubic 
centimetre (one-fourth of a teaspoonful) of 
water one degree. It has been ascertained that 
a strong man at hard work requires sufficient 
food to produce 3054.6 calories per day. 

The foods available for the nourishment of 
the body are divided into four classes: pro- 
teids, or tissue formers (eggs, beef, fish, and a 
large part of beans and peas) ; carbohydrates, or 
heat and energy producers (sugar, starch, cere- 
als, and the root crops) ; fats, heat and energy 
producers (the fat portion of beef, the oils both 

103 



Rural Hygiene 

from the animal and vegetable kingdoms) ; in- 
organic substances, such as salt and water, 
which aid the body in utilizing the other foods. 

No one of the different classes of food is alone 
able to support life. Man has learned by experi- 
ence that a mixed diet only will maintain the 
body in perfect condition and science has con- 
firmed these practical observations. Recently 
certain students have stated that, as a nation, 
we consume more food than is necessary, 
especially meats. They have kept men at hard 
work and in perfect health for many months 
on a diet which would seem starvation to most 
persons. Convincing as these experiments ap- 
pear, it seems best that each man should regu- 
late the amount of food eaten by the nature of 
the work done, and that the appetite regulated 
by reason is, at present, the best guide for the 
diet of the individual. There is no doubt 
that many of our people eat more than they 
require, especially those whose work is seden- 
tary. In this class are the excessively fat and 
corpulent, who, by their over indulgence in 
food, are shortening their lives, besides depriv- 
ing themselves of much pleasure. 

The following table shows the relation be- 
104 



Food and Diet 



tween height and weight at different ages, 
based on the results of life-insurance examina- 
tions. These are not to be considered hard and 
fast, but any marked departure therefrom 
should put the person on guard. The heights 
are with the shoes on and the weights with 
the clothing on, but without overcoat. 



Height. Aj 
5 ft. o in 1 20 



5 ' 


1 1 " 


5 ' 


' 2 " 


5 ' 


3 " 


5 ' 


4 " 


5 ' 


5 " 


5 ' 


' 6 " 


5 ' 


' 7 " 


5 ' 


■ 8 " 


5 ' 


9 " 


5 ' 


' 10 " 


5 ' 


1 11 " 


6 ' 


" 


6 ' 


' 1 " 


6 ' 


' 2 " 


6 ' 


3 " 



L5-24 


30-34 


40-44 


50-54 


120 


128 


133 


134 


122 


129 


J 34 


136 


124 


131 


136 


138 


127 


134 


139 


141 


131 


138 


143 


145 


134 


141 


146 


149 


138 


145 


150 


153 


142 


150 


155 


158 


146 


154 


160 


163 


150 


159 


165 


167 


154 


164 


170 


172 


159 


169 


175 


177 


165 


175 


180 


182 


170 


181 


186 


188 


176 


188 


194 


194 


181 


195 


203 


201 



As a nation we eat too fast, drink too much 
water at meals, and do not chew our food 
sufficiently. All these errors cause indigestion, 
but of the three failure to chew is probably 
the most serious. The first step in the digestion 
of food is accomplished in the mouth, the 

105 



Rural Hygiene 

secretions of which help to soften the food and 
also change the carbohydrates into products 
that are absorbable by the tissues. Mr. Horace 
Fletcher has for years been preaching to us 
about chewing our food. He maintains that 
by so doing the quantity eaten will be reduced 
and at the same time the body will be better 
able to do its work. After nine years on a re- 
stricted diet, during which time he has chewed 
persistently, he was tested in the gymnasium 
of Yale University and his endurance was 
double that of the best trained men there, 
although he had not been in training and was 
fifty-nine years of age. Whether others can 
equal his work on the same diet or not, there is 
no question of the beneficial results of thor- 
oughly masticating the food. 

ECONOMY IN DIET 

This is a matter of little importance to a few 
of our people, but to the great majority it is 
necessary to make their money go as far as 
possible. To them it is a matter of great im- 
portance to obtain the best diet possible and 
that most suited to the needs of the family with 
the least expenditure. Doctor 0. W. Atwater, 

106 



Food and Diet 

who made this question an especial study for 
many years, speaks in the following language: 

"Scientific research, interpreting the obser- 
vations of practical life, indicates that a four- 
fold mistake in food economy is very commonly 
made. First, the costlier kinds of food are used 
when the less expensive are just as nutritious 
and can be made nearly or quite as palatable. 
Second, the diet is apt to be one-sided, in that 
foods are used which furnish relatively too 
many fuel ingredients (fats, sugars, and starches) 
and too little of the flesh-forming material. 
Third, excessive quantities of food are used; 
part of the excess is eaten, often to the detri- 
ment of health; part is thrown away in the 
table- and kitchen- waste. Finally serious errors 
in cooking are committed." 

The Department of Agriculture has for some 
years been studying the foods available for 
use by our people and in the "Year Book for 
1902" will be found a summary of the results, 
giving the values of our food products as 
regards the nutriment they furnish. In these 
studies it has been shown that ten cents spent 
for flour, beans, or salt fish will nourish the 
body better than fifty cents expended on 

107 



Rural Hygiene 

tenderloin steak, lobsters, or fresh salmon. 
In this connection it must be remembered that 
man's appetite must be taken into account 
and that it is impossible for him to live on the 
same kind of food day after day, and that the 
desserts and many other articles which furnish 
very little nutriment are of value in stimulating 
the appetite. 

Faulty cooking is one of the greatest evils 
under which our race lives. The poor have their 
food undercooked or improperly cooked, while 
the rich live on highly seasoned and delicately 
prepared foods which very often produce seri- 
ous disturbances of the digestion. Fried foods 
and other greasy dishes cause a great deal of 
indigestion. There is little doubt that much 
of the drunkenness in the world is the direct 
result of lack of proper nourishment, caused by 
bad cooking and unpalatable food. 

Ignorance and improper methods are respon- 
sible for much of the faulty cooking. Mr. 
Edward Atkinson, who made a study of cook- 
ing, found that a large portion of the time 
devoted to it was consumed in endeavoring to 
overcome the faults of the modern stove. In 
genera] the great fault was found to be the 

108 



Food and Diet 

inability to regulate the heat and the tendency 
to have the fire too hot. He therefore applied 
himself to the problem of overcoming the 
faults of the stove, and as a result devised a 
method of cooking by a moderate degree of 
heat in an insulated oven. The heat in his 
method is applied by means of a lamp placed 
under the oven, the latter being enclosed in an 
insulated box. The oven when constructed 
costs considerably more than an ordinary stove, 
but one can be improvised from a tin box 
placed inside a packing box that is lined with 
tin. The name of the stove is the Aladdin and 
it can be operated at a cost very much below 
that of any other stove. This invention has 
not been used as much as it should, but with 
the development of electricity this, or a similar 
method, will undoubtedly become popular. 

The tireless cookers, of which there are a 
great number on the market, are great labor- 
saving devices and an aid to those who cannot 
afford an expensive cook. With further de- 
velopment they will become very popular. 
The name is not correct, for it is necessary to 
partially cook the food over an ordinary fire, 
after which it is placed in an air-tight box 

109 



Rural Hygiene 

lined with a substance that will not radiate 
heat. Food placed in such a box will slowly 
cook and at the same time retain all the aromas 
which are lost in the ordinary methods of pre- 
paring food. Any person can make such a 
cooker from articles on the farm, straw being 
a most excellent insulating material. 

The great difficulty with the tireless cooker 
and other similar devices is that there is no 
provision for hot water, which is a necessity 
in the modern household. In the winter months 
the kitchen fire also heats a portion of the house 
and for that reason it cannot be dispensed with 
until some other source of heat is provided. 

MEATS 

Good meat is of a uniform color and is neither 
pale nor purplish. The feel is firm and elastic 
with an absence of pitting and crackling. The 
odor should be very slight, and meat that has 
the slightest odor of decomposition must be 
condemned. The cut section should barely 
moisten the finger. Meat that is decomposing 
becomes moist upon exposure to the air. Bull 
beef is darker and has a stronger flavor than 
that from cows or steers. 

no 



Food and Diet 

Beef and mutton are more readily digested 
than is pork. The fancy cuts of beef appeal to 
the palate, but when expense is considered they 
are far inferior to the round and other despised 
portions. Tough meat has the advantage that 
it must be thoroughly masticated, which is good 
for the digestion and also for the teeth. It is 
said by some dental surgeons that one of the 
causes of the decay of our teeth is lack of use. 
It is said that tough beef can be rendered 
tender by being placed in equal portions of olive 
oil and vinegar and kept on the ice for several 
hours. 

Flesh from diseased animals has been eaten 
in many instances, especially that of those dead 
from tuberculosis and anthrax, yet in most 
cases the result has been disastrous and it is 
in the long run best to condemn all such car- 
casses. The Federal meat inspectors are allowed 
under certain circumstances, to pass meat from 
diseased animals, and those who desire to know 
the conditions under which this is done are 
advised to consult the latest instructions of the 
Department on the subject. 

When meat or fish has undergone decompo- 
sition, poisons are developed which no amount 

in 



Rural Hygiene 

of cooking can destroy. These are the result 
of germ growth and are very dangerous. Not 
infrequently flesh which appears to be fresh 
contains these poisons and it is wise to refrain 
from using any meat or fish about which there 
is any suspicion. 

Tape-worms, trichinae, and other parasites are 
transmitted to man through the flesh of animals. 
They may be killed by thorough cooking but 
no amount of smoking or pickling will destroy 
them. It is wise to refrain from eating raw or 
underdone meat unless it is known to be free 
from these parasites. This subject will be 
considered more in detail under the subject of 
parasites. 

FISH 

As regards digestibility fish occupies about 
the same place as beef, but there is great dif- 
ference in this respect between the several 
kinds of fish. Those which contain a consider- 
able quantity of fat, such as the salmon, are 
less readily digested than are those with white 
meat. There are many prejudices against fish, 
most of which are without foundation. In 
common with other foods they are only fit for 
consumption when perfectly fresh. When 

112 



Food and Diet 

taken from polluted waters they are liable to 
cause disease. This is especially true of the 
shell-fish. Many epidemics of typhoid fever 
have been traced to the use of oysters or clams 
which had been fattened at the mouths of 
sewers. Ordinary cooking, especially steam- 
ing or making into soup, will not kill the germs 
contained in shell-fish. 

As long as the fish is firm and free from odor of 
decomposition it is fit for food, but should it 
crush under gentle pressure or have the slightest 
suspicion of the odor of decomposition it must 
be rejected at once. Fish that are killed as 
soon as taken from the water keep better than 
those which are allowed to slowly die. 

CANNED FOODS 

Canned foods enter largely into the dietary 
of our people, especially during the winter 
months. When properly preserved they are 
excellent substitutes for the fresh articles, but 
a steady diet of such food not infrequently 
leads to indigestion and loss of appetite. It is 
said by some that foods that have been canned 
for a long time undergo some chemical change 
which renders them unfit for consumption, 
8 113 



Rural Hygiene 

and that their use may cause symptoms of 
poisoning. Such cases are generally reported 
from labor camps and tramp steamers the 
supplies of which are purchased in remote 
parts of the globe and from the cheapest 
sources. Well -prepared canned foods have 
been eaten in the Arctic regions after many 
years, and it is believed that the products of 
reliable houses will keep indefinitely. 

Cans that are battered or that bulge at the 
ends are to be rejected, as the contents have 
generally undergone fermentation. 

Poisonous chemicals are rarely used in the 
process of preserving foods. The recent Federal 
food laws, supplemented by those of the several 
States, seem to be a safeguard against adultera- 
tion and improper method of preserving. 

There are occasional cases of metallic poison- 
ing from the action upon the can of the acids in 
the foods ; this rarely occurs except with the 
products of inferior factories. The author has 
never seen a case of such poisoning. 

Smoked and salted foods are much used and 
are wholesome when properly cured. It is to 
be remembered that no process will make a 
bad article good and that salting and smoking 

114 



Food and Diet 

will not kill the parasites of trichina or of tape- 
worms when they are in the beef or pork. 

PREPARED FOODS 

Many of our people are purchasing the break- 
fast foods so widely advertised under the im- 
pression that they contain a larger amount of 
nutriment than do similar articles sold in the 
market without the fancy names. This is not 
the fact, for they are all predigested cereals, 
and, while such foods may be of service in cases 
of sickness, a healthy person does not require 
to have his food predigested. When such diet 
is used it eventually results in weakening of the 
secretions of the stomach and so causes ill 
health. The oatmeal, hominy, and rice sold in 
the stores as such are as good as the more expen- 
sive articles made from the same ingredients 
but sold under high-sounding names. 

Beef extract is another article about which 
there is a popular misconception. Some years 
ago the papers contained the statement that 
the nutriment from an entire beef had been con- 
densed in a small can. These advertisements 
have disappeared, but many persons believe 
that beef extract is a particularly strong prepa- 
id 



Rural Hygiene 

ration of beef. The fact is that, like all such 
fluids, it contains only the extractives from the 
meat and is in no sense nourishing. It is a 
stimulant and is of value as such but not as 
food. 

CEREALS 

In our modern dietary, cereals are represented 
by oatmeal, cracked wheat, hominy, and rice, 
and are largely used by those in moderate cir- 
cumstances. They belong to the class of energy - 
and heat-producers, and when used in excess 
produce fat, but, being lacking in the tissue- 
producing elements, the body is badly nourished. 

LEGUMENS 

These are represented by the beans and peas 
and are rich in the tissue-producing elements. 
They should be more generally used, especially 
as meat has become so expensive that many 
cannot afford to buy it. 

ROOT CROPS 

The root crops consist largely of starch and 
sugar, especially the potato and beet, which 
are the most used. Some of them, such as the 
carrot, parsnip, and radish, contain large 

116 



Food and Diet 

amounts of extractives and very little nourish- 
ment, but they are useful as relishes. 

GREEN VEGETABLES 

The green vegetables contain acids and salts 
which are of value as relishes and also prevent 
scurvy. They deserve to be more generally 
used. 

FRUITS 

Fruits are very palatable and consist largely 
of acids and sugar. They stimulate the appe- 
tite and are laxatives. 

NUTS 

Nuts contain some fat and some of the tissue- 
producing elements, and, although not so read- 
ily digested as are the other fats, are, never- 
theless, valuable articles of food, and the 
American people should make more use of 
these natural products. Almonds, chestnuts, 
peanuts, and cocoanuts are the ones most 
commonly found in our markets. 

STIMULANTS 

Coffee and tea are stimulants that are prob- 
ably used in excess by many of our people, and 

117 



Rural Hygiene 

there is little doubt that they contribute to the 
nervous disease from which our race suffers. 
Used in excess they also cause disorders of 
digestion, yet compared with other stimulants 
their harm is insignificant. 

Cocoa, as made in this country, is both nour- 
ishing and stimulating, but there are persons 
with whom it does not agree. Probably in 
many such cases, by diminishing the quantity 
of sugar and milk used, the difficulty can be 
overcome. 

The question of alcohol has been considered 
in another section; it is sufficient here to say 
that it is a drug which may in a slight degree 
contribute to the nutrition of the body, but that 
its bad effects are so much greater than its 
good ones that it should be considered only as 
a drug and used as such. It is more dangerous 
to the community than morphine and cocaine 
and its sale should be restricted in the same way. 
This can only be accomplished by education of 
the public. The recent movements in the south 
and west certainly appear to indicate that this 
may be accomplished in the near future. 



118 



Food and Diet 

GARBAGE, SLOPS, AND OTHER REFUSE 

The garbage from the kitchen is usually fed 
to the chickens or hogs. If properly done this 
practice results in no nuisance, nor it is unsani- 
tary ; but when it is thrown on the ground, and 
the uneaten portions are allowed to accumulate, 
it becomes a breeding place for flies and is 
unsanitary in other ways. Probably the most 
satisfactory method of caring for this class of 
refuse is to bury it in the garden, covering it with 
not more than ten inches of soil. A very small 
plot of ground will care for that from a large 
family, and by turning up one or two spades of 
earth it can be covered each day. If promptly 
covered it will neither cause an odor nor will 
it become the breeding place for flies. Burning 
the garbage is rarely satisfactory because of 
the odor; it is also an unnecessary waste of 
fertilizer. 

Slops may be emptied into the drains of the 
Waring system, or where this has not been 
installed they may be strained through some 
straw and the liquid allowed to run through a 
perforated gutter into the garden. On either 
side of the gutter should be planted shrubs or 
vegetables. The ground on which the water 

119 



Rural Hygiene 

runs should be raked over each day. The straw 
through which the slops have passed should be 
burned or buried as soon as it begins to accumu- 
late filth. 

In some localities the slops are run through 
a pipe into a trench that has been partially 
filled with broken stone and covered with a 
few inches of earth. 

Around a country house there is always a 
considerable quantity of solid refuse, such as 
tin cans, paper, old shoes, broken crockery, 
and bottles. Those for which there is a sale 
should be saved for the junk dealer. The others 
must be disposed of in such a manner that they 
will not become a nuisance. Those portions 
which are combustible should be burned. 
Ashes may be used for walks or for filling low 
ground. Cans must never be thrown about, 
as they collect water and become the breeding 
places for mosquitoes. They are best burned 
and then used with the ashes for filling. 

It is well to provide receptacles for the dif- 
ferent classes of rubbish so that there will be 
no difficulty in sorting it. This may be accom- 
plished by hanging sacks on hoops or iron 
supports. 



VII. 

WINES, WHISKEY, AND OTHER ALCOHOLIC DRINKS 



The temperance question has been before 
the country for a long time and until the last 
few years seemed to be making no headway, 
but the elections of 1907 in the south showed 
that in that section at least, a majority of the 
voters favored sobriety. 

All persons will agree that the abuse of alco- 
hol, whether in the form of whiskey, beer, or 
other drinks, causes more misery than all the 
other evils combined. The burden of this 
generally falls upon the women and children 
or upon those least able to bear it. Whether 
we believe in total abstinence or not, most 
persons are agreed that moderation is desirable. 
Few persons desire to have a saloon located 
next to their residences or places of business. 

The real status of alcohol is that it is a drug, 
and should be so considered both by the public 
and before the law. When first taken into the 
body it exalts the nervous system and stimu- 

121 



Rural Hygiene 

lates the circulation. This is soon followed by 
a depressed condition, and if the dose be suffi- 
ciently large there are loss of coordination and 
self-control, reduced ability to withstand cold, 
and lessened capacity for hard work. 

The use of alcohol as a drug is diminishing 
every year. There are undoubtedly times when 
moderate stimulation by alcohol may be desir- 
able, but this is a question for the physician 
who is confronted by the condition. As a rule 
our people are better off without the use of 
alcohol even in the shape of wines taken at 
meals. 

As our American society is constituted, we 
have a large number of persons who drink 
alcohol in some form or other; many use it in 
moderation, but the number who indulge to 
excess is very large and is constantly being 
recruited from the moderate drinkers. This 
we cannot stop at once, so it becomes neces- 
sary to study the matter, hoping thereby to 
be able to remove some of the causes which 
lead so many of our people to poison them- 
selves with alcohol. 

My observations, based upon association 
with all classes of persons in all parts of the 

122 



Alcoholic Drinks 

country, have caused me to believe that the 
following are some of the reasons why men 
drink: 

i. Most men are socially inclined, and a glass 
of liquor taken with friends promotes good 
fellowship and stimulates the flow of conversa- 
tion for a time. Later it often causes quarrel- 
ling. 

2. Many of our people are undernourished 
and drink because they feel the need of a 
stimulant to carry them through their day's 
labor. This lack of nourishment is due to the 
cost of food, bad cooking, and the lack of 
knowledge of domestic economy. 

3. Many young men have no place to spend 
their evenings. If poor, they live in partly 
furnished rooms that are cold and cheerless, 
and the only warm and cheerful place where 
they are welcome is the saloon. Here they 
find company and their welcome lasts as long 
as they make an occasional purchase. 

4. Many a hard worker is unable to throw 
off the cares of business when the office closes 
and takes home with him the troubles of the 
day. This man finds that indulgence in alco- 
holic drinks cheers him up and allows him the 

123 



Rural Hygiene 

relaxation he desires. These are the hardest 
cases to manage. 

5. Many men are social outcasts, not because 
of any offence they have committed, but be- 
cause of diffidence and lack of training they are 
afraid to mingle with the society of the locality 
in which they live. These men gradually 
become hard drinkers, for when their loneliness 
oppresses them they resort to drink to relieve 
themselves. 

If you can find the cause for a man's drink- 
ing you can generally help him. It has been 
my good fortune to have done so in a number 
of cases. 

It is said that the amount of drinking in the 
rural districts is increasing. In those localities 
where this is true it would be well for the better 
citizens to consider the question along the lines 
given above, see what the cause is, and deter- 
mine what can be done to relieve the condition. 
Many of the country lads who go to the cities 
fail because they take to drink ; not that they 
are inferior to their city competitors, but 
because they lack the company and home sur- 
roundings to which they are accustomed. 
This I have observed many times in the large 
cities of our country. 

124 



Alcoholic Drinks 

The country store where the men congre- 
gate is too often a saloon, and to counteract 
its influence there should be provided a better 
place to gather. This has been done in some 
localities by starting a club where both men and 
women can congregate. Move the post office 
from the store and you make a reason for going 
there every day. Whether there should be any 
drinking there must be determined by the 
members. This matter has been considered 
under work and recreation. 

When one of your neighbors becomes ad- 
dicted to the use of alcohol do not look upon 
him as a criminal but as one who is sick. 
Endeavor to help him in every way. 



VIII. 

MILK 



Next to bread, milk is probably the most 
important article in the diet of the American 
people. The returns of the census for 1900 
showed that, excluding the quantity used in 
the rural districts, our people consumed on 
an average 23 gallons per person per year. 

How to obtain this quantity of milk in a pure 
state and transport it to the consumer without 
deterioration and at the same time sell it at a 
price which will remunerate the producer for 
his labor and not place the cost beyond the 
means of the average citizen, is one of the 
greatest problems before the country. At pres- 
ent the farmer does not receive a proper com- 
pensation for his portion of the work, and the 
consumer has to pay too much for his milk. 

A number of years ago laws were enacted in 
most of the States requiring that milk offered 
for sale should conform to a fixed chemical 
standard. In most of the States these laws 

126 



Milk 

required that the total solids should not fall 
below a certain percentage, but more impor- 
tance was attached to the percentage of fat, 
which in most cases was required to be between 
2.4 per cent, and 3.4 per cent. With the growth 
of the science of bacteriology it was learned 
that the number of bacteria in the milk was of 
far greater importance than the chemical com- 
position. Application of this knowledge to the 
handling of milk has resulted in increased 
purity of that supplied to our people. 

This movement for the improvement of the 
milk supply should receive the support of all 
classes of the community. The producer and 
vendor are benefited because their losses are 
less and the price obtained is better. The con- 
sumer receives a better article for his money 
and the health of his family is not endangered. 
Generally the public is benefited because the 
death-rate, especially among children under one 
year, is greatly reduced by the use of pure milk. 

The sanitary requirements of milk are : that 
it come from healthy cows, which have not been 
fed on unwholesome food or food that will 
impart an unpleasant odor to the milk; that 
it be drawn and handled with the most minute 

127 



Rural Hygiene 

regard to cleanliness ; that it be cooled as soon 
as drawn to 45 and kept at or below that 
temperature until used. 

To obtain the best results from cows they 
must be well cared for. In summer they may 
be allowed the liberty of a clean pasture, 
provision being made for their protection from 
the direct rays of the sun during the heat of the 
day, and from the rain and wind during bad 
weather. An abundance of pure water is to be 
provided, running water if possible, otherwise 
in troughs. They must never be allowed to 
drink from polluted streams or stagnant pools. 
During the heat of the day cows will wade in 
the water to cool themselves, and if it be pol- 
luted they will become foul and it will be diffi- 
cult to obtain pure milk from them. 

If cows become excited or are driven hard, 
the quality as well as the quantity of the milk 
is changed. In districts where flies are trouble- 
some it is often necessary to smear the cows 
with some preparation of soap in order to afford 
protection from the insects ; a better way is to 
darken the stable and allow the animals to 
stand in the stall all day, using the pasture after 
dark. 

128 



Milk 

In winter and during bad weather it is best 
to keep the milk cows in a well-ventilated 
stable, at least 1200 cubic feet of air-space being 
provided for each animal. The ceilings of the 
barn are to be from nine to twelve feet high, 
and there should be one window of from four 
to six square feet in area for each animal. 
Cement or brick walls are the best, but these 
are only possible in a very few cases and just 
as satisfactory results can be obtained by using 
matched boards covered with building paper 
or other insulating material. Cracks should 
not be left in the wall, as they not only harbor 
insects but admit draughts which interfere with 
ventilation and cause the cows to suffer from 
colds. In the model stable the floors of the 
stalls and the feed-boxes are made of cement, 
but rammed clay is often used for the floor, 
and matched boards for the feed-boxes. In 
width the stall should allow room for the ani- 
mal to lie comfortably. The floor should slope 
to the rear and end in a gutter of cement 
or rammed clay, from sixteen to twenty-four 
inches deep, to catch the excreta. If moldy 
bedding be used it will contaminate the milk 
and cause a loss to the farmer. The importance 
9 129 



Rural Hygiene 

of dryness in the stable is not appreciated by 
many farmers. Each cow excretes about seven 
pounds of moisture daily in its breath, and 
when arranging for the ventilation this must be 
considered. The ventilation in many stables 
is far from what it should be. A physician once 
stated that some farmers found it to their 
apparent interest to keep their animals warm 
at the expense of proper ventilation and loss 
of health. Animals which are kept in moist, 
warm, badly-ventilated stables are prone to 
have tuberculosis and it is to the interest of 
the farmer to keep his herd free from that 
disease if possible. 

The stable should be so faced that it will 
receive the maximum amount of sunshine. 

MILKING 

The milker should be dressed in clean white 
clothing that can be laundried. Under no 
circumstances should ordinary working cloth- 
ing be worn. Such garments are usually 
filthy, from the standpoint of the bacteriologist, 
and are perfumed with all the odors from that 
of the manure pile to the pig-pen. Before 
beginning operations the milker must clean his 

130 



Milk 

nails and wash his hands with soap and brush, 
rinsing them in boiled water. At least half an 
hour before milking the cow should be groomed 
and the udders and teats wiped with a cloth 
that has been wrung out in sterile water. 

Observance of these rules will greatly reduce 
the number of bacteria in the milk. In one 
instance the reduction amounted to six thou- 
sand per cubic centimetre (one-fourth of a 
teaspoonful) . The purity of milk is greatly 
increased if the milking be done in a room 
that is used for no other purpose, but where this 
is impossible, the cleaning of the stable and the 
grooming must be completed at least half an 
hour before the milking is begun. The milker 
should not moisten his fingers in the milk, 
as is often done, but should have a cup of 
boiled water for that purpose. The first milk 
drawn contains many bacteria and should be 
discarded. 

The wide-mouthed pails so commonly used 
serve no good purpose and are great collectors 
of dust and dirt. Tall narrow pails with the 
openings covered with sterile gauze, as shown 
in the illustration, are in use in all modern 
dairies. It has been found that by their use 

131 



Rural Hygiene 

the number of bacteria and the amount of dirt 
in the milk are greatly reduced. 

Cows give more and better milk if milked 
at regular hours and by the same person. If 
the calf is to have a share he must be kept 
away from the cow until all the milk that is 
required has been drawn. If the calf be allowed 
to suck at the time of milking there will be an 
increase in the number of bacteria in the milk. 
The best plan is to feed the calf from the first 
from a bucket. 

The time is not far off when a practical and 
sanitary milking machine will be invented. It 
should be able to obtain the maximum quantity 
of milk from the cow, without annoying her, 
and at the same time be so constructed that it 
can be kept sterile. Some of the machines now 
on the market fulfil the mechanical require- 
ments, and with great care can be kept in good 
sanitary condition, furnishing better milk then 
than can be obtained by hand milking. It is 
believed, however, that the difficulty of keep- 
ing them clean is such that they cannot be 
used by the ordinary dairyman. 

As soon as drawn the milk is to be taken to 
the cooling room and the temperature rapidly 

132 



Milk 

reduced to 45 ° by placing the containers in 
running water or in iced vats. The value of 
this procedure is well illustrated by the experi- 
ment carried on by the Chicago milk inspectors 
during the summer of 1907. They took eight 
gallons of fresh milk at the dairy and placed it 
in two four-gallon cans, marking them "A" 
and "B" respectively. At the time the cans 
were sealed there were 11,500 bacteria in each 
cubic centimetre of the milk. Can "A" was 
handled by the farmer in the usual way while 
"B" was treated in the same way excepting 
that it was immediately cooled to 45 ° and 
shipped on ice. After twelve hours, when the 
milk was examined at the retailers, can "A" 
showed 114,000 bacteria while in can "B" 
the number was only 7800. At the end of 
twenty-four hours, when the milk was being 
delivered to customers, the number of bacteria 
in "A" was 1,300,000, while in "B"but 62,000 
were present. 

THE WAY MILK BECOMES CONTAMINATED 

Milk may become infected with bacteria in 
many ways. Not infrequently the milker's 
hands are contaminated by handling articles 

133 



Rural Hygiene 

that have come in contact with those sick with, 
or convalescent from, contagious diseases. 
Even with the greatest care more or less dust 
and dirt from the stable will get in during the 
milking and these nearly always contain germs. 
Milk pails that are washed by those in attend- 
ance on the sick are always infected. An im- 
pure water supply may contaminate the cans 
that are washed in it or the milk that is kept 
therein to cool. Flies which get into the cans 
or the milk are one of the greatest sources from 
which germs of disease are communicated to the 
milk. Cans and bottles that are not sterilized 
are always a source of danger. In some houses 
the empty bottles are used for many purposes 
which are uncleanly to say the least. At the 
retailer's counter the dipper is a source of 
contamination. 

The importance of excluding as many germs 
as possible is shown by the following experi- 
ment, in which the germs of typhoid fever were 
placed in the milk at the time it was drawn 
from the cow, subsequent examination giving 
the following results: 

Number of hours o 2 6 8 12 24 

Number of bacteria 78 50 42 46 460 6000 

134 




Fig. 14. — (a) Separate parts of Gurler covered 
pail. (From Bulletin 48, of the Storrs Agricultural 
Experiment Station, by permission of L. A. Clinton, 
director.) 




Fig. 14. — (b) Gurler covered pail equipped 
with absorbent cotton strainer ready for use. 
(From Bulletin 48, of the Storrs Agricultural 
Experiment Station, by permission of L. A. Clinton, 
director.) 



Milk 

This table also shows the property which 
clean fresh milk has of preventing the growth 
of germs. This property appears to be ex- 
hausted in about eight hours when the milk is 
kept at 45 , but is lost much more rapidly 
when the temperature is above that point. 
At best this power is feeble and cannot be 
depended upon to render the milk safe. Some 
persons deny that it exists at all. It is destroyed 
by boiling or pasteurizing. Milk that is treated 
by either of these methods deteriorates rapidly 
if bacteria are introduced. 

The utensils used at the dairy should be of 
the best tin, and made of but one piece, or, if 
of several pieces, the joints are to be well 
soldered and made as smooth as possible. 
The pails and cans should have small mouths 
but without abrupt corners. They should be 
washed in cold water as soon as empty and 
then in hot suds, being then rinsed in cold 
water and afterwards sterilized. If hot water 
be used first, the remnants of the milk will 
coagulate on the vessel and will then be removed 
with difficulty. Bottles should be treated in 
the same way. 

Milk absorbs odors very rapidly, especially 
i35 



Rural Hygiene 

that of the male goat, tobacco, carbolic acid, 
and creosote ; therefore the presence of these in 
and around the room in which the milk is 
handled must be prohibited. Disinfectants are 
costly and are not needed when the stable and 
dairy are kept clean. 

MILK ADULTERATIONS 

The recent Federal and State laws have 
practically prevented the adulteration of milk. 
The principal frauds now practiced in its sale 
are: 

i . Skimming off the cream. 

2. Watering. 

3. Adding thickening agents. 

4. Adding coloring matter. 

5. Adding substances to alter the taste or 
to increase the amount of solids. 

6. Adding preservatives. 

Skimmed milk is common, and where it is 
sold as such there is no objection, since the pur- 
chaser knows what he is getting. The color 
of skimmed milk is a dead white or a bluish 
white, while normal milk is a yellowish white. 

Water is sometimes added to milk to increase 
the quantity. This is a distinct fraud. It is 

136 



Milk 

also a matter of sanitary import, as the water 
used is frequently impure. Epidemics of ty- 
phoid fever have been started in this manner. 

Substances added to milk to change the 
taste are in themselves generally harmless, 
being mostly soda or sugar which are used to 
prevent the sour taste ; but milk to which these 
substances have been added is usually unfit for 
use and should not be sold. 

Coloring matter is added to conceal imper- 
fections and to cover up the rascality of those 
who skim it and sell it as whole milk. The 
dyes used are in some cases poisonous, while 
in others they only interfere with the diges- 
tion. The man who adds coloring matter to 
his milk should be severely punished. 

Preservatives are added to make dirty milk 
keep longer. These are harmful, not only 
because some of them are poisonous, but be- 
cause they allow an inferior quality to be sold 
to the public. This practice is to be condemned 
from every point of view. 

STERILIZATION AND PASTEURIZATION OF MILK 

Some persons advocate destroying the germs 
in milk by pasteurization or by sterilization. 

137 



Rural Hygiene 

In the first instance it is heated to 176 degrees 
and in the second case to 212 degrees. Either 
method will destroy most of the germs, but it 
also changes the digestibility of the milk so 
that, in some cases, children fed on it develop 
scurvy. Another objection is that it is difficult 
to carry out the process on a large scale and 
that milk improperly treated is frequently 
worse than in the raw state. 

Unless contaminated milk is treated as soon 
as it is taken from the cow, the germs which it 
contains will develop toxins and no amount of 
cooking will render it fit for food. If left in 
the raw state this milk would rapidly spoil 
and be thrown away. It is safest to handle 
the milk in such a way that the chances of 
becoming contaminated will be reduced to a 
minimum and then to keep it cold, thus prevent- 
ing the growth of the germs as much as possible. 

The milk is readily affected by the cow's 
diet, and especially by foods that have a strong 
odor, such as garlic and turnips. The milk from 
cows fed with slops and brewery refuse is not 
fit for food, because of the bad taste. When 
brewery grain is fed, the alcohol finds its way 
into the milk and makes it unfit. 

138 



Milk 

DISEASES TRANSMITTED TO MAN THROUGH MILK 

The following diseases are transmitted to 
man through the medium of milk : tuberculosis, 
typhoid fever, cholera, summer diarrhoea of 
children, diphtheria, scarlet fever, milk sick- 
ness, foot-and-mouth disease, anthrax, cowpox, 
rabies, actinomycosis (lumpy jaw). Garget, a 
disease of cows, produces symptoms of diar- 
rhoea in man. 

TUBERCULOSIS 

Several years ago, Doctor Robert Koch 
raised the question as to whether man could 
contract tuberculosis from animals suffering 
from the disease. This caused the entire sub- 
ject to be studied anew and the general opinion 
is that human beings can contract the disease 
from animals through milk, especially when 
this is used as food for young children. The 
International Congress on Tuberculosis, which 
was held at Washington in 1908, indorsed this 
opinion ; practically the only dissenting opinion 
being that of Doctor Koch. 

It has long been known that milk of cows 
which show no evidences of the disease, but 
which react to the tuberculin test, contains the 
germs. Not infrequently the udder is the seat 

139 



Rural Hygiene 

of the disease and in such cases the germs are 
always found in the milk. 

An examination of the milk supply of the 
City of Washington showed that out of 223 
samples offered for sale 6.7 per cent, contained 
tubercle bacilli. Of 102 dairies supplying the 
city, the milk from 10.2 per cent, was found to 
contain the germs of tuberculosis. Many cows 
which show no evidences of the disease, except- 
ing the reaction to tuberculin, pass tubercle 
bacilli in their faeces. Such cattle are very 
dangerous, for, although there are none of the 
bacilli in the milk as it comes from the teats, 
their hindquarters are almost invariably infected 
and even with the greatest care some of the 
germs from that source will get into it. 
The bacilli are also found in the dust of the 
stable in which tuberculous cattle are kept 
and this is one of the sources from which the 
milk is contaminated. The tuberculous cow 
is therefore a menace to the health of the 
human race. 

The disease is very prevalent among cattle 
in the United States. During the five years 
ending with 1905 the Federal meat inspectors 
examined 29,360,136 carcasses, condemning 

140 



Milk 

14 per cent, as infected with tuberculosis. 
Tuberculin tests made in the State of New 
York from 1905 to 1907 showed that 36 per 
cent, of the animals tested had the disease. 
These figures are somewhat higher than is the 
infection among cattle in general. 

Tubercle bacilli will live a long time in 
butter and cheese and it is therefore undesir- 
able to use infected milk in the manufacture 
of these products. Hogs that are fed on milk 
from cattle with tuberculosis develop the 
disease. 

The farmer is interested in the prevention of 
tuberculosis, not only because of the danger of 
members of his family contracting it, but also 
because of the loss it causes among his cattle. 
When the question of the prevention of the 
ravages of the disease among cattle was first 
agitated, it was suggested that all animals hav- 
ing it should be killed, and in a number of 
States such a policy was pursued. This soon 
met with disfavor from all classes, and it was 
demonstrated that no government could long 
stand the drain upon its treasury. Fortunately 
such a policy is no longer necessary. Professor 
Bang of the Copenhagen Veterinary College 
141 



Rural Hygiene 

has devised the following plan, which allows 
of the reestablishing of a healthy herd from 
one that is infected with but slight loss to the 
farmer: All animals which show symptoms 
of the disease (cough, diarrhoea, or emaciation) 
are destroyed. Those with no symptoms but 
reacting to the tuberculin test are isolated and 
kept for breeding purposes. They are watched 
with great care, and any that develop symp- 
toms of the disease are at once destroyed. The 
calves from the infected herd are taken from 
the mother as soon as born and suckled by 
healthy cows or fed with their own mothers' 
milk after it has been sterilized. Should any 
of the calves develop scours or appear sick 
they are at once tested with tuberculin. The 
stable in which the diseased animals have been 
kept must be thoroughly disinfected before 
being used for healthy cattle. The pasture on 
which tuberculous cattle have been kept should 
be used for some other purpose for a year 
before having healthy cattle put upon it. 

Tuberculosis is spread to a great many 
herds by cattle that are imported, and it should 
be a rule not to make additions to the herd 
until the new-comers have been proven to be 
free from the disease. 

142 



Milk 

TYPHOID FEVER 

Typhoid fever is frequently caused by drink- 
ing milk that has been infected with the germs 
of this disease. Doctor Kober of Washington 
has collected 195 epidemics due wholly to 
infected milk, mostly from contamination at 
the farm. During the year 1906, 866 cases of 
the disease occurring in Washington were 
studied by the Public Health and Marine 
Hospital Service of the Federal Government. 
Of these 85 were traced to milk infection, occur- 
ring among the customers of three dairies. 

Milk is one of the best culture media for 
growing the typhoid bacillus. The germ may 
get into it through the unclean hands of those 
who do the milking, or by being blown around 
in the dust, or through infected water with 
which pails or bottles are washed, or flies may 
bring the infection on their feet. Not every 
case of typhoid fever is of sufficient severity 
to cause the patient to stay in bed. Often 
persons well along in the disease are walking 
about and not infrequently such persons are 
found in the dairy, milking. Those in w T hose 
families the disease exists should not be allowed 
to work about the dairy. This applies also to 
such diseases as diphtheria and scarlet fever. 

143 



Rural Hygiene 

To keep milk from becoming contaminated 
with typhoid fever the following rules should 
be observed : 

Locate the dairy in good surroundings. 

Prevent persons who have just recovered 
from the disease or those in attendance on 
persons sick with it from handling the milk. 

Exclude flies from the dairy. 

Sterilize the bottles and cans before they are 
used. 

Seal all bottles and cans as soon as filled and 
keep them cold. 

There are persons who carry the germs of 
typhoid fever in their bodies for years after 
recovery. They are known as "typhoid Car- 
riers' ' and are very dangerous to the com- 
munity. In some instances these persons are 
engaged in the dairy business and their influ- 
ence is extended to a large community. When- 
ever there are cases of the disease that cannot 
be accounted for a search should be made for 
carriers. 

DIPHTHERIA 

Kober's statistics show 35 epidemics of 
diphtheria due wholly to milk. In Ashtabula, 
Ohio, 100 persons became sick with this 

144 



Milk 

disease in December, 1894, and upon investiga- 
tion it was shown that all the houses in which 
it was present obtained their milk from one 
source. At the dairy it was ascertained that 
one of the workmen had had a very sore throat 
but had continued working. 

SCARLET FEVER 

Kober collected 95 epidemics of scarlet fever 
wholly depending upon milk. There have 
been numerous epidemics in all parts of the 
world in which the source of infection was 
definitely traced to dairies where persons con- 
valescing from the disease assisted in the 
operations of milking or handling the milk. 

CHOLERA AND DYSENTERY 

Cholera and dysentery are usually water- 
borne diseases but can also be transmitted by 
milk. The milk in most instances becomes 
infected through the water used to wash the 
utensils, but in some cases water added to it 
causes the trouble. 

SUMMER DIARRHCEA IN CHILDREN 

In this country the greatest amount of sick- 
ness directly traceable to bad milk is in the 
10 145 



Rural Hygiene 

summer diarrhoea of children (summer com- 
plaint). The prevention of this is largely a 
matter of clean milk, and the mortality from 
the disease is being reduced as the people are 
becoming more educated to the importance of 
such milk. In Rochester, New York, it is 
estimated that during the past ten years 2486 
lives of young children have been saved by 
supplying clean milk during the summer 
months. 

MILK SICKNESS 

This disease is primarily one of cattle, but is 
occasionally transmitted to man. In one local- 
ity in New Mexico there were thirty-eight cases 
in human beings during the past ten years, the 
population of the town being about two thou- 
sand. The disease appears to be less prevalent 
than it was some years ago. It is sometimes 
limited to certain pastures, those which are 
separated therefrom by only a fence being 
apparently free. The cause is said to be a 
poisonous plant, but this is by no means 
certain. 

Cattle affected with the disease mope and 
droop, walking with a faltering gait and stag- 
gering when caused to run. They are not 

146 



Milk 

infrequently unable to avoid objects in their 
path. 

Just how man becomes infected is not known, 
but it is generally believed that the flesh, as 
well as the milk of animals suffering from the 
disease, can cause the infection to be trans- 
mitted to man and other animals. 

ROPINESS IN MILK 

Ropiness in milk is caused by certain bac- 
teria which get into it through water in which 
the utensils are washed, or through the hands 
of the milkers. Such milk is not always harm- 
ful, but in this country there is no sale for it 
and every precaution should be exercised to 
exclude the germs. 



IX. 

ICE 



Many disease germs are greatly weakened 
by freezing, yet this is not always the case. 
An epidemic of typhoid fever was traced to ice 
that had been in storage seven months and the 
germs were recovered from the ice. Ice from 
small streams and ponds is nearly always 
polluted, and the ice from the Hudson River 
is open to grave suspicion as the fields from 
which most of it is cut are in the immediate 
vicinity of the outlets of sewers. The upper 
Hudson River receives the sewage of 210,000 
persons and there is one part of sewage to every 
three hundred parts of water. 

In Vermont the examination of a few sam- 
ples of ice from ponds showed them all to be 
unfit for use. Ice that is formed upon pure 
water may become contaminated in many 
ways. Not infrequently the harvesters flood 
it to increase thickness, and they are not 
always particular to see that pure water is 

148 



Ice 



used for this purpose. The cutting and delivery 
of ice is fraught with many dangers. In the 
first place the workmen may be infected with 
typhoid fever or other diseases that are trans- 
mitted through water. The custom of placing 
ice on the curb or the back porch insures that 
it will be contaminated with any germs which 
may be deposited in such localities. The house 
servants who handle it may be suffering from 
disease. Ice wagons as now used are most 
dangerous affairs. They are open and collect 
all the dust and dirt which blows. In the winter 
they are occasionally used as ash carts or for 
other purposes equally as bad. In the city of 
Washington I have more than once seen filthy 
colored boys riding in such carts and it is not 
an unknown occurrence for tramps and other 
vagabonds to sleep in them at night. 

An examination of the artificial ice in the 
large cities has shown that in many instances 
it is far from pure and in some instances it 
contains more germs than the water from which 
it is made. This is due to great carelessness on 
the part of the manufacturer. 

Ice should be cut from the purest sources 
available. In general that manufactured is 

149 



Rural Hygiene 

better than the natural. It should be delivered 
in closed wagons that are kept clean. The 
householder should provide a covered bucket 
or box to receive the ice from the wagon, and 
the ice-man should be compelled by law to 
close the cover after depositing the ice. 

In the country there are many localities 
where ice from infected sources is all that is 
available. The farmer should remember this 
and use it for refrigeration only; under no 
circumstances should he place it in his drink- 
ing water or place his food on it. The ice 
should be kept in a separate compartment 
from the articles that are to be refrigerated 
and the only communication should be through 
an air shaft so located that none of the water 
from the ice can get into the food compartment. 

ICE-WATER 

During the warmer months our people seem 
to require a cooling drink, and without doubt 
moderately cool water is the least harmful. 
A sufficient degree of cold can be obtained by 
placing the water on the ice for a few hours, 
and under no circumstances should ice be placed 
in the water. High degrees of cold are undesir- 
able and probably harmful. 

150 



Ice 



ICE-CREAM AND ICES 

There has been a great deal of discussion as 
to the bad effects of ice-cream and ices. There 
seems to be little doubt that very cold sub- 
stances taken into the stomach tend to tem- 
porarily diminish the flow of the gastric fluids, 
and in some instances the taking of large 
quantities of ices at meals may produce indiges- 
tion. The practice of finishing a meal with an 
ice is, to say the least, not beneficial. The 
proper time for taking such refreshments is 
between meals, and I firmly believe that they 
fill a place during the warm season that is not 
filled by anything else. 

Studies of these products as sold in one of 
the larger cities has shown them to be far from 
the pure article that they are generally sup- 
posed to be. In many cases samples of ice- 
cream contained a large number of bacteria. 
Not infrequently the cream and ices are manu- 
factured in insanitary basements or other 
places which are unfitted for the purpose. 

Doctor Vaughan, of Ami Arbor, Michigan, 
has reported a number of cases of poisoning 
traced to bacterial poisons generated in ice- 
cream. In 1906 there were six cases of typhoid 

151 



Rural Hygiene 

fever in the city of Washington traced to the 
use of infected ice-cream. 

Ices and ice-cream are best made at home 
of milk or cream that is above reproach, and 
it is to be remembered that after cooking, milk 
and cream are better culture media for bacteria 
than when fresh. For this reason greater care 
should be used to keep them from becoming 
contaminated. An improved freezer which 
would prevent the contents from ever coming 
in contact with the ice is very desirable. 

Ice-cream should be eaten as soon after being 
frozen as possible, and under no circumstances 
should it be kept over until the next day and 
then refrozen. Most of the cases of poisoning 
have been from cream that has been kept for 
some time. 



X. 

COUNTRY STORES, JAILS, AND GOOD ROADS 

In many parts of the country the store is 
the general meeting place of the inhabitants. 
Here the men and boys congregate and await 
the mail in surroundings that are frequently 
far from sanitary. Especially is this true in 
the winter or during rainy weather, when the 
building is closed up. The author has a vivid 
recollection of a long winter afternoon spent in 
such a store. The building was low and but a 
few feet above the ground. The stock com- 
prised a little of everything, from fresh meat 
and vegetables to dry goods and soft drinks. 
In the centre was a red-hot stove, around which 
sat the men of the community, some reeking 
with the odor of the stable and all wet and 
steaming from the drying of their clothing. 
Many were chewing tobacco and their expecto- 
ration was received into several large boxes of 
sawdust, which from appearances had not been 
emptied for many days. One man was plainly 

153 



Rural Hygiene 

a consumptive, but he enjoyed the privileges of 
the spittoon as did his neighbors. There were 
several windows and two doors opening into 
the room, but none of them were open, and the 
only fresh air received was that which entered 
when a new arrival passed through the door. 
In one corner was a bar at which soft drinks 
were sold, and it was well patronized. The 
glasses were never washed, but were rinsed off 
in a bucket of very questionable fluid kept 
beneath the counter. 

There is nothing exaggerated about the above 
description, and I have seen the same condition 
in many parts of the country. The store in 
question I have known for over twenty years 
and it has always been as described. 

All store-keepers feel that they must display 
their vegetables and fruits so as to attract trade. 
Not infrequently they place such things in open 
boxes on the sidewalk or on the floor of the store. 
Here they accumulate all the germ-laden dust 
possible, beside the spittle, from careless 
chewers. Besides which a dog occasionally 
voids his urine against the box. This is not a 
very pretty picture, but it is a true one and can 
be verified in the city or in the country. I see 

154 



Jails 

such things almost daily in certain parts of 
Boston. Those who patronize the store can 
remedy this by refusing to purchase any food 
that is kept under such circumstances. Glass 
is not so expensive but that the store-keeper 
can afford to use a little of it to protect his 
wares from the dust and dirt. Insist on it and 
you will get it and it will not bankrupt him 
either. 

JAILS 

Unfortunately it will be a long time before 
we can do without jails, and until that time 
comes it will be necessary to provide a place 
of detention for those persons who are danger- 
ous to their fellows. Many of our prisons are 
sadly lacking in sanitary appliances, and in not 
a few the ventilation is extremely bad. We 
should remember that, while detention is the 
first object, such institutions should be edu- 
cational as well. We should endeavor to 
procure for those incarcerated, proper food, 
light, and ventilation, and provide them with 
the means of self -improvement, hoping they 
may become good citizens when released. The 
air space should not be less than 600 cubic feet 
per man, and proper methods of disposal of 

i55 



Rural Hygiene 

excreta and other refuse must be provided. 
Personal cleanliness should be insisted upon, 
and the means of securing it should be within 
the reach of every prisoner. The number of 
persons who contract tuberculosis in our jails 
is a disgrace to the community. 

The jail should be regularly inspected by the 
health officer and he should have power to 
compel the keeper to take proper precautions 
to safeguard the health of those confined in it. 

GOOD ROADS 

The dust from an ordinary road contains 
sharp particles of stone and sand, soil that has 
been reduced to a fine powder, and a consider- 
able quantity of manure. In dry weather this 
mixture gets into our noses, lungs, and eyes, 
causing irritation of these organs. In wet 
weather the roads are filled with mud holes 
which contain all manner of decomposing ma- 
terials. This is far from healthful. The farmer 
therefore should support the good road move- 
ment. Good roads directly benefit him by 
reducing the cost of hauling, and also enable 
him to get to town more often and thereby 
enjoy more of life. The roads are not local 

156 



■op 
?§• 

?o" 
1 

3 




Good Roads 

matters, and it seems that their improvement 
should be charged in part to the general 
public. Especially is this true since the auto- 
mobiles have come into general use. Fast 
moving autos raise great clouds of dust, and 
for that reason alone the speed should be 
regulated and the regulations rigidly enforced. 



XL 

FLIES, MANURE, AND SLAUGHTER-HOUSES 



Flies are not only a nuisance but are one 
of the means of disseminating typhoid fever, 
cholera, and diarrhoea among human beings, 
and surra and anthrax among horses and 
cattle. 

In this country we are most interested in the 
house-fly, which in reality should be called the 
stable-fly, for it breeds by preference in horse 
manure, although it will utilize any collection 
of animal or vegetable matter when manure is 
not accessible. During the winter months 
many of these insects hibernate in cellars, lofts, 
or other protected places, and with the first 
warm days of spring, frequently as early as 
March, they sally forth and soon begin to 
deposit their eggs. In the vicinity of Wash- 
ington it has been demonstrated that each 
female deposits about one hundred and twenty 
eggs each time she lays. These will develop 
into flies in about ten days, depending upon 

158 




Fig. 16. — This is a plate of jelly over which a fly, taken from a 
butcher's stall in the Washington Market, walked. The dark spots are 
colonies of germs left on the plate by the fly's feet. The plate was in- 
cubated for 24 hours and then photographed by Dr. Wm. M. Gray. 
(Published by permission of Major F. F. Russell, U. S. Army, Curator 
Army Medical Museum.) 



Flies 

the temperature. In all about thirteen genera- 
tions will develop in that region during an ordi- 
nary summer. The offspring of one fly during 
an ordinary summer may amount to several 
million. 

The relation of the fly to the different diseases 
will be more fully considered under each one. 

In certain portions of the country there are 
flies which deposit their eggs in animal tissues, 
where they hatch, the larvae causing great 
destruction of tissue. The nose and the ear 
are the most favorite localities for their activi- 
ties in the human race, although they will 
infect any open wound that is available. From 
the nose they not infrequently invade the brain, 
and unless the condition is promptly treated 
death is the result. 

The prevention consists in never sleeping in 
the open air during the day unless covered by 
a mosquito net. All open wounds should be 
covered with gauze. 

There are occasionally cases of severe diar- 
rhoea that are caused by the larvae of flies 
(maggots) in the intestines. They gain access 
through food that has been left uncovered and 
often there are many hundreds of them in the 

159 



Rural Hygiene 

intestines. The condition is rarely dangerous 
and the larvae are readily removed by purga- 
tives, such as castor oil or salts. The prevention 
consists in keeping the flies from the food. 

Intestinal infections appear to be more com- 
mon in the eastern part of the country, while 
larvae in the nose and in the open wounds are 
more commonly found in Arizona and other 
parts of the southwest. 

In the Philippines many horses have been 
killed by surra which is transmitted by a fly 
abounding in that country but apparently 
unknown in the United States. 

MANURE 

Many of our people do not appreciate the 
value of the manure produced in this country. 
In our cities little effort is made to conserve 
this valuable product. Elaborate systems have 
been developed for the removal of the drop- 
pings of animals from the public streets, but 
none of them, as far as has come to the atten- 
tion of the author, has endeavored to save the 
manure for the agriculturist. The general plan 
is to use the street sweepings for filling in low 
ground, but in some instances they are dumped 

160 



Manure 

into the sea. All of this is a direct loss to the 
country. Manure represents the waste material 
of the food which has grown on the land, and 
true economy demands that it should be 
returned to the land to supply the elements 
used by the growing vegetation. Any other 
method of disposal tends to rob the soil of its 
fertility. 

In the rural districts most of the manure is 
returned to the land, but very often it is 
handled in such a way that there is an unneces- 
sary loss of fertilizer. Scientific agriculturists 
say that the sooner the manure is gotten on the 
land the better. There will also be less loss. 
Fortunately the best interests of the farmer are 
served by managing the manure in a sanitary 
manner. During a considerable portion of the 
year it is impossible to spread it on the land 
and some method of storage must be provided. 
While in storage it loses in value through the 
two following causes: (i) Fermentation, 
whereby a certain portion of the nitrogen is 
lost; (2) weathering and leaching, which 
cause a loss of soluble constituents, such as 
phosphate and potash. To prevent these losses 
the manure should be stored in sheds with 
11 161 



Rural Hygiene 

cement floors, or, better, in cement -lined pits. 
These pits or sheds must be fly proof. It has 
been found that if litter to the extent of one- 
third of the dry food consumed by the animal 
be used, the urine will be absorbed. Keeping 
the pile moist will delay the fermentation. 
The use of preservatives has not proven satis- 
factory, but the pile should be as compact as 
possible. It is open to question whether manure 
sheds pay for themselves, but when the sanitary 
side of the matter is considered there is no doubt 
as to their value. 

The following general rules for the manage- 
ment of manure are recommended: i. Place 
it on the land as soon as possible. 2. Spread 
it out uniformly. 3. Keep the air out as much 
as possible. 4. Keep it moist but not wet. 
5. Protect it from extremes of heat or moisture. 

In providing for the storage of manure it 
should be remembered that the average product 
of the various farm animals is as follows: 

Tons per year 

Horse 6.5 

Steer 20.9 

Cow 15.0 

Hog 1.8 

Sheep 8 

162 



Slaughter-houses 

These quantities vary according to the char- 
acter of the food, green foods producing a 
greater quantity than dry foods. 

Fowls produce a considerable quantity of 
manure which, if not properly attended to, 
will become the breeding place of flies. It is 
also to be remembered that a daily cleaning of 
the hen-house will insure better health among 
fowls. 

SLAUGHTER-HOUSES 

For many reasons the beef killed in the rural 
districts is not as good as the western refrig- 
erator beef. There is a tendency on the part 
of the small butcher to kill only those cattle 
for which there is no sale in the large cities. 
In some instances animals that are diseased are 
killed, especially those with tuberculosis. This 
is more likely to occur in those States where 
there is no meat inspection by the State 
authorities. 

The country slaughter-house is a nuisance in 
most cases. It is generally surrounded by dirty 
pens and stands upon ground that is reeking 
with untold filth. All the refuse is, as a rule 
thrown on the ground just outside the build- 
ing, where it is devoured by hogs and stray 

163 



Rural Hygiene 

dogs. The building is the home of rats, and 
countless flies breed in the decaying refuse and 
walk at liberty over the carcasses of the ani- 
mals which are hung up to cool. 

The above is not a true picture of all country 
slaughter-houses, but it is a good description 
of a majority of them. The large packing 
houses are more sanitary at present, and their 
products are better because of the Federal and 
State supervision recently established over 
them. It has been suggested to consolidate the 
rural abattoirs and to employ inspectors to 
supervise their sanitation as well as inspect the 
animals slaughtered in them. This is in the 
interest of the health of the community and 
should have the support of all good citizens. 

A modern slaughter-house should be as nearly 
fly proof as possible and well ventilated. The 
floors should be of cement sloping to a central 
gutter, and the sides, to a height of at least two 
feet above the floor, should be of the same 
material. Above this the walls should be of 
some smooth material, free from cracks and 
crevices in which particles of blood or other 
refuse can lodge. The gutter should empty 
into a movable vat protected from flies. After 

164 



Slaughter-houses 

each killing the floor and walls should be 
scrubbed or washed down with water and the 
table on which the carcass is cut up washed 
with hot water and lye. The vat should be 
removed as soon as possible and its contents 
either burned, buried, or converted into fertil- 
izer. The ground must be kept as clean as 
possible, and under no circumstances should a 
hog-pen be maintained within a thousand yards 
of the slaughter-house. 

There is no reason why the slaughter-house 
cannot be kept as clean as a kitchen or butcher 
shop. The butcher should wear clean clothing 
and cleanse his hands before cutting up the 
carcass. Beef should be transported in closed 
wagons, protected from dust and flies. 

The rats which infest the slaughter-house are 
one of the means of spreading trichinosis to 
hogs. Stiles has found that about 50 per cent, 
of the slaughter-house rats are infected, while 
in Boston the percentage is somewhat greater. 

Dogs that feed on the offal of abattoirs are 
often infected with the bladder worm which 
causes serious disease in man. It is therefore 
advisable to keep dogs away from the premises. 

The following diseases may be transmitted 
165 



Rural Hygiene 

to animals from slaughter-houses : tuberculosis, 
anthrax, hog cholera, and swine plague. For 
this reason it has been advised that animals 
which enter the pens at the abattoirs should 
not be returned to the herd unless quarantined 
for sufficient time to insure that they are free 
from disease. 



XII. 

HOGS 



Hogs are found on almost every farm, and 
with the increased cost of beef this hog raising 
will assume a greater importance each year. 
The flesh of hogs is highly nutritious and the 
cost of production is much less than of beef. 
Many of the animals sold in this country are 
raised amid the most unsanitary surroundings 
and fed upon the most improper food, the result 
being that they become the means of spreading 
disease to man, and are themselves subject to 
many diseases which cause a great loss to the 
farmer. 

The hog in his native state inhabits a region 
where the climate is moderately severe and 
where there are extremes of heat and cold. 
He must, however, have protection in winter 
and shade and an abundance of water in sum- 
mer. He feeds on grain and vegetation, but 
should be kept where his food and water can 
be procured with a minimum amount of labor. 

167 



Rural Hygiene 

He requires a varied diet, but corn is probably 
the cheapest and most satisfactory food, and 
almost as good results can be obtained by 
feeding barley, oats, or wheat. Alfalfa is a 
favorite food in some parts of the west, and 
peas, beans, peanuts, and acorns are largely 
used in the south. In the dairy regions 
many are fed upon skimmed milk from the 
creameries. Where milk is used great care must 
be exercised lest it be contaminated with 
tubercle bacilli, and unless it is known to be 
free from such germs it should be sterilized. 
Root crops are much used for winter feeding, 
but if given in large quantities the animal will 
suffer from diarrhoea. The feeding of brewery 
refuse and offal from slaughter-houses should 
be prevented by law. 

Although the flesh of hogs which are fed on 
kitchen slops is not as good as is corn-fed pork, 
it is believed that a moderate use of such food, 
combined with corn or other grain, will produce 
good meat. It is not advisable for the farmer 
to import large quantities of kitchen refuse for 
his hogs, as is done in the vicinity of some of 
the large cities. 

The feeding troughs should be shallow, with 
as few crevices as possible and sufficiently 

168 



Hogs 

stout to resist the teeth of the animals. Those 
made of concrete and surrounded by a concrete 
floor are the most sanitary. Whatever the 
nature of the trough, it and its surroundings 
must be kept very clean. Hogs can be kept 
without causing the unpleasant odors so char- 
acteristic of most stys in this country. 

In construction of piggeries four things are 
essential : light, ventilation, warmth, and clean- 
liness. Under cleanliness especial attention 
must be paid to dryness and ease of removal 
of refuse. The fewer cracks in the walls the 
better, as they harbor insects and other vermin. 
The manure, which is a valuable fertilizer, 
should be removed at frequent intervals and 
stored under the same conditions as is horse 
manure. The inside of the building is to be 
washed at least once a month with a 5 per 
cent, solution of carbolic acid. 

Where the climate permits, hogs do better 
if kept in pastures where there is running 
water that is above reproach as to its purity. 
The field is to be fenced with woven wire that 
is from thirty to thirty-six inches high and 
above which may be stretched several strands 
of barbed wire. 

The practice of placing pens over streams is 
169 



Rural Hygiene 

only mentioned to be condemned. It is far 
from uncommon, and some years ago the 
author came across a large pen located over a 
small stream which emptied into the reservoir 
from which the city of Washington drew its 
water. Hog cholera has been transmitted 
through water, and it is therefore advisable not 
to allow the animals to enter the stream, but 
to provide a trough for their bathing and 
drinking and to run the water from the trough 
through irrigation trenches. 

The interests of the hog raiser are identical 
with those of the health officer and these should 
co-operate and endeavor to enforce cleanliness 
both in the pen and on the range. This will 
diminish the mortality among animals and im- 
prove the health of the dwellers in the rural 
districts. 

The diseases which may be transmitted to 
man are trichinosis and tape-worm. 

Trichinosis is transmitted to the hog through 
the faeces of animals or man that are infected, 
as well as through flesh, and especially through 
the refuse and rats from slaughter-houses. 
Man contracts the disease by eating under- 
cooked meat, raw pork, or ham. 

170 



Hogs 

In some sections tape-worm is a very com- 
mon infection. The disease is transmitted to 
the animals through the fasces of other animals 
infected with the disease or through the fasces 
of man. Man contracts the disease by eating 
raw or partially cooked pork and also by eating 
food that has been contaminated by being 
washed in infected water, or directly through 
his own hands, which have come in contact 
with the eggs of the parasite and have not 
been washed. 

This is one of the most serious infections, as 
the parasite may find its way into the brain, 
the eye, or other organs and cause death. 
The worms in the intestines of men do not 
cause serious symptoms but there is reason to 
believe that they pave the way for more danger- 
ous diseases of the body. 

It is not impossible that the vermin on the 
bodies of hogs may be one of the ways of trans- 
mitting diseases to other animals, and it is 
therefore important that hogs should be kept 
as free from these pests as possible. This may 
be accomplished by keeping their pens clean 
and by dipping the animals from time to time 
as may be necessary. 



XIII. 

INTESTINAL PARASITES 



There is a host of parasites living within 
the human body. Many of them apparently 
do no harm, while not a few are the cause of 
serious disease. Even when no symptoms are 
produced their presence is a source of consider- 
able annoyance, and some physicians claim 
that they make the body susceptible to other 
diseases. Intestinal parasites are said to be 
three times as common in the rural districts 
as in the cities. 

ROUND-WORMS 

Probably the most common of these animals 
is the round-worm. Generally they cause no 
symptoms, and the first indication of their 
presence is the passage of one or more of them 
with the faeces. Occasionally they migrate to 
other parts of the body and cause serious 
symptoms. 

The embryos enter the body through the 
medium of infected food or water, and children 

172 



Intestinal Parasites 

not infrequently infect themselves by sucking 
their fingers. 

If the food and water be kept pure and 
measures are taken to prevent children from 
sucking their fingers there is little danger of 
infection. 

TAPE-WORMS 

The tape- worms are far from uncommon. 
Four different worms infect the human body; 
the beef -worm, the fish-worm, the pork-worm, 
and the bladder-worm. The embryo of the 
latter is the only form in which it is found in the 
human body. 

The eggs of the first three are passed from 
the body in the fasces, and after undergoing 
some development in the soil are swallowed by 
the animal in which they are found. Here they 
develop into embryos and lodge in the muscles, 
where they may remain for an indefinite time. 
Man becomes infected by eating the flesh which 
contains the embryos. The eggs of the pork- 
worm can develop in the human body. This 
worm at times causes serious disease of the 
brain or of the eyes. In general the only symp- 
tom of tape-worm infection is loss of flesh. 

The embryos are destroyed by thorough 
173 



Rural Hygiene 

cooking, but smoking or pickling does not kill 
them. If kept in cold storage they are said to 
die in twenty-seven days. 

The prevention consists in thoroughly cook- 
ing all meat or fish unless it is known to be free 
from the embryos. In addition all stools which 
contain the eggs should be destroyed by fire. 
No person with the disease should be allowed 
to defecate in a field used for pasture. As it is 
difficult to know whether persons have the 
disease or not, it should be a rule on the farm 
that no person be allowed to defecate in the 
fields. 

The most serious of all the tape-worms is 
the bladder-worm. It is not very common in 
America but its prevalence is increasing. The 
mature worm is generally found in the dog, 
but other animals harbor it. In man the 
embryos are generally found in the liver or 
lungs and cause serious disease. The only 
treatment is surgical, but the results are not 
very satisfactory. 

Dogs become infected by feeding on the 
offal from slaughter-houses, and Stiles, the 
leading American authority on these parasites, 
says that no dog which has entered the grounds 

174 



Intestinal Parasites 

of a slaughter-house should be allowed to leave 
it alive. The eggs leave the dog's body in the 
faeces, and the hair of the animal's hindquarters 
is always soiled with its dejections. Persons 
who fondle dogs which have the disease are 
always in danger of contracting it. 

The prevention consists in destroying as 
many of the stray dogs as possible and in 
refraining from fondling any unless they are 
known to be free from the disease. Dogs which 
are infected should be killed unless they are 
valuable, in which case they may be isolated 
until cured, care being taken to disinfect all 
of their excreta by fire. 

ANKYLOSTOMIASIS (Miners' or Cotton Mill Ansmia) 

This disease is more prevalent in hot than in 
cold climates. In Porto Rico it causes a large 
number of deaths, and the majority of the 
population at the time of the American occu- 
pation were found to be infected. Recent 
studies have shown that it is very prevalent in 
the southern part of our country. Often it is 
epidemic in mines, but those of the United States 
are apparently free from any serious infection. 



175 



Rural Hygiene 

The disease is caused by a minute worm which 
makes its home in the large intestines of human 
beings. It attaches itself to the mucous lining 
of the gut and is believed to draw blood from 
its victim. At times there are many hundreds 
of them in the intestines. 

The eggs are passed with the faeces, and if 
deposited on warm moist ground develop into 
larvae which gain access to the human body 
through the mouth, either with water or foods 
that have been handled by dirty hands. The 
most common portal of entry is through the 
skin of the legs of those who run bare-footed on 
ground that is infected. It has been proven by 
direct experiment that the larvae can pass 
through the skin in a comparatively short 
time. In countries where the disease prevails 
there is a very common skin disease of the 
legs called ground itch, and in recent years it 
has been learned that this is but an inflamma- 
tion caused by the passage of the larvae through 
the skin. 

The prevention consists in disinfecting the 
stools as is done in typhoid fever. Personally 
those who live in communities where the 
disease prevails should be very particular 

176 



Intestinal Parasites 

about cleansing their hands and faces before 
eating, and should also see that their food and 
water supply is above reproach, or else take 
measures to render them so. Great care should 
be taken to disinfect lettuce and other vege- 
tables that are eaten raw, as the larvae often 
adhere to these, and no amount of ordinary 
washing will remove them. In order to sterilize 
green vegetables that are eaten raw they should 
be placed on ice until very cold and then passed 
rapidly through boiling water and immediately 
returned to the ice chest, but not placed upon 
the ice. 

Persons residing in regions where the disease 
prevails should not go barefooted. 

Regarding the disposal of the faeces in dis- 
eased communities, Doctor C. W. Stiles, who 
has devoted much time to the study of the 
parasite, says: "I would say that hook-worm 
eggs die very rapidly if subjected to fermenta- 
tion, less rapidly if excluded from oxygen. 
Accordingly the septic tank seems a splendid 
method of getting rid of them. The earth 
closet appears theoretically at first a good 
method, but practically the fecal material is 
often not covered with sufficient earth to 

12 177 



Rural Hygiene 

exclude the oxygen. Personally I favor the 
pail system, the frequent emptying of the pail, 
and burial of the night soil in the case of farms 
or burning of night soil where feasible in com- 
munities. " 

TRICHINOSIS 

This is caused by a parasite which is found 
in the hog and several other domestic animals. 
In man it is a serious disease and not infre- 
quently results in death. Probably the pri- 
mary host of the parasite is the rat. This ani- 
mal keeps the infection alive by eating its 
comrades which have died of the disease, and 
by eating the offal of hogs that are slaughtered. 
In Boston, Billings found that from 75 to 100 
per cent, of the rats captured in the slaughter- 
houses harbored the parasite. Of 2,227,740 
hogs inspected in the United States during 
1899, 41,659 were found infected. The para- 
site is not so common in this country as in 
Europe, yet it is more common than is gen- 
erally supposed. Stiles collected 900 authentic 
cases which had been reported during the 
thirty-six years ending with 1905, and Williams, 
who examined 505 dead bodies in Buffalo, 
found the parasite in 5 per cent. The disease 

178 



Intestinal Parasites 

was three times as prevalent among the Cana- 
dians and Italians as among the Americans. 

It is transmitted from animal to animal 
through eating the flesh of those which have 
the disease or through foods that have been 
soiled with the excrement of animals which 
have it. Hogs become infected by being fed 
on slaughter-house refuse, man by eating the 
raw or partially cooked flesh of hogs. Smok- 
ing and salting do not, as a rule, kill the 
parasite, and the practice of eating raw ham 
and sausage, which is far from uncommon in 
certain sections, is very dangerous. 

As a result of experiment we have learned 
that pork which harbors the parasite must be 
raised to a temperature of 160 before it can 
be considered safe. If the pork be boiled we 
must allow eighteen minutes for each pound 
plus half of the time required to bring the water 
to a boil. Roasting should be continued until 
the red color has disappeared. Cooking to 
such a degree does not make a very palatable 
dish for the average American, and it is there- 
fore better to purchase only pork that is above 
suspicion. 



XIV. 

MALARIA, TETANUS, DIARRHOEA AND DYSENTERY 

Malaria is one of the diseases which is more 
prevalent in the rural than in the urban dis- 
tricts. It is caused by a minute organism 
that passes a portion of its life in the red 
blood-corpuscles of man. The rest of its life is 
passed in the body of a mosquito of the family 
Anopheles. The disease is transmitted from 
man to man through the agency of this mos- 
quito. The malarial mosquitoes are usually 
brown or yellowish in color, with spotted 
wings and straight proboscis. They do not 
hum as much as other insects. When resting 
on the wall the body is nearly at right angles 
to the surface, and the head, body, and pro- 
boscis are in a straight line. Their larvae (wig- 
glers), which are generally found in pools of 
clean water or comparatively still water or of 
sluggish streams, have straight breathing tubes 
and rest parallel to the surface of the water. 
If disturbed they dart back and forth and sink 

180 



Malaria 

with difficulty. They are rarely found in rain 
barrels. 

These mosquitoes do not fly far. Occasion- 
ally they have boarded vessels at a distance of 
a mile from the shore, but as a rule those found 
around the house are bred in its immediate 
vicinity, possibly in shallow pools in the grass, 




Fig. 17. — Resting position of Culex (at left) and Anopheles (at 
right). (From Howard, Bulletin No. 25 N. S., Division of Entomology, 
United States Department of Agriculture.) 

in tree-hollows, or on the leaves of plants. Their 
time of greatest activity is from just before 
sunset until shortly after daylight, for they 
avoid draughts and during the day secrete 
themselves in the thick foliage of the garden 
or in the darker corners of the house. Not 
infrequently they hide beneath the bed. 

181 



Rural Hygiene 

In order to prevent malaria it is necessary to 
adopt measures against the mosquito. The 
householder should see that there is no uncov- 




Fig. 18. — At top, half-grown larva of Anopheles (malarial mosquito) 
in feeding position, just beneath surface of water. At bottom, half-grown 
larva of Culex in breathing position. Greatly enlarged. (From Howard, 
Bulletin No. 25 N. S., Division of Entomology, United States Depart- 
ment of Agriculture.) 

ered water about his premises in which they 
can breed. In this connection it is well to 
remember that mosquitoes breed in the water 
of privies, cesspools, and rain barrels, and that 

182 



Malaria 

where there is such water it should be oiled or 
protected by wire gauze. The oil will have to 
be renewed at least once in ten days. One 
ounce of oil to fifteen square feet is sufficient 
to prevent mosquitoes from breeding in water. 
Screen your houses, doors, windows, and venti- 
lators, with wire gauze of eighteen strands to 
the inch. This will not only prevent mosquitoes 
from entering but will exclude flies. 

In the eastern and southern parts of the 
United States there are large tracts of land 
practically uninhabited because of the mos- 
quitoes, which make it impossible for persons 
to work there with comfort. As a rule these 
are the salt marsh mosquitoes which breed in 
great numbers and fly a great distance, so that 
towns free from marshes or other breeding 
places are often alive with these insects. 

Experiments made in New York and New 
Jersey show that it is possible to reclaim these 
marshes and do away with the mosquito pest. 
The work is really not a local affair and the 
State should undertake it, the owners of the 
land repaying the entire or a portion of the 
cost, as is being done in the irrigation projects 
in the west. In this connection attention is 

183 



Rural Hygiene 

called to the fact that the Federal Government 
is continually dredging from the rivers and 
harbors of the country material which could 
be well used in this work. In most instances 
this is dumped out at sea, when it could in 
many cases be used for filling the swamps at 
greatly reduced cost. 

Marsh land that has been reclaimed is usu- 
ally very fertile, and when placed under culti- 
vation will repay the cost of the work put upon 
it. Especially is this true in the vicinity of 
large cities where such land can be turned into 
truck farms. These lands may be worked 
somewhat earlier in the spring than others and 
are less liable to be damaged by drought and 
frost. This subject is fully discussed in Farm- 
er's Bulletin Number 187, which may be had 
from the Secretary of Agriculture and should 
be in the hands of those who have swamps on 
their premises. 

Other diseases that are transmitted by 
mosquitoes are yellow fever and dengue, both 
of which are found in the United States and 
have prevailed as far north as Boston. 

If you have occasion to sojourn in a com- 
munity where there are mosquitoes, provide 

184 



Malaria 

yourself with a good square net of not less 
than eighteen strands to the inch and sleep 
under it all the time. Head nets can be ob- 
tained from dealers in sporting goods. They 
are small and so occupy little space in the 
baggage and will enable you to spend many 
a comfortable night that otherwise would 
be anything but pleasant; besides they will 
prevent you from contracting malaria. The 
author has carried one of these ever since 1899 
and has never regretted it. Never put your 
trust in oils that are to be smeared on the 
body. They are of no value, for as soon as 
they begin to dry the pests will be at you again, 
and sometimes they even sting through the oil. 
I have frequently seen them do the latter. 

Before entering the net be sure that there 
are no mosquitoes within it. Not infrequently 
the servants or those making the beds, fold or 
roll up the net in such a way that the insects 
get beneath it during the day. This is very 
common, and in the best hotel in New Orleans 
I have always found mosquitoes within it. 
Nets should not be hung on the outside of the 
bed posts, but suspended from the inside, 
and they must be tucked under the mattress- 

185 



Rural Hygiene 

They should be entered through as small an 
opening as possible and tucked under the 
mattress at once. Unless the bed is large the 
hands or other portions of the body are liable to 
come in contact with the netting and be bitten 
through it. To prevent this it is well to have 
a flounce about six inches wide placed around 
the net at such a distance from the bottom that 
it will just rest on the top of the mattress. 

Occasionally mosquitoes will enter a house 
that is screened, and it may become necessary 
to fumigate to destroy them. This is accom- 
plished by closing up all the cracks with paper 
and burning insect powder at the rate of one 
pound for each thousand cubic feet of air space 
in the room. After two hours the room is 
opened and the stupefied or dead insects are 
swept up and burned. This latter may be 
facilitated by darkening all the windows but 
one, where the mosquitoes will congregate in 
their endeavor to escape. 

All persons should be actively interested in the 
extermination of mosquitoes. Excepting where 
there are marshes this can be accomplished at 
no great expense, but it requires the co-opera- 
tion of all the families in the neighborhood. 

186 



Diarrhoea and Dysentery 

TETANUS (Lockjaw) 

There are not a few deaths from this disease 
in the rural districts. It is caused by a germ 
which lives in the soil, especially in that of 
gardens and stables. The dung of horses often 
teems with tetanus germs. They will not live in 
wounds that are exposed to the air, but grow 
rapidly in punctured wounds, especially those 
made by splinters or nails. The disease is 
most prevalent following Independence Day, 
due to the injuries made by toy pistols. 

The prevention consists in keeping all wounds 
clean and free from infection. Punctured 
wounds should be opened and thoroughly 
cleansed with a solution of peroxide of hydro- 
gen, and dressed with sterile gauze moistened 
in a solution of bichloride of mercury one part 
to one thousand parts of water. 

DIARRHOEA AND DYSENTERY 

Under these names are classed a number of 
diseases which are not fully understood. In 
fact diarrhcea and dysentery are really only 
symptoms. The following are some of the 
causes: eating overripe or green fruit, eating 
other spoiled foods, drinking water that con- 

187 



Rural Hygiene 

tains a large amount of animal or vegetable 
matter, exposure of the abdomen to cold. The 
prevention consists in avoiding the causes. 

There are several kinds of dysentery. One 
is caused by a little organism which lives in 
water and is found on the leaves of growing 
plants. This form is commonly called tropical 
dysentery, but it is far from uncommon in this 
country. There is another variety which is 
caused \>y a germ found in all parts of the 
world. To this latter group belongs the sum- 
mer diarrhoea of children (summer complaint). 

The prevention of dysentery is one of the 
greatest problems before the nation. It is one 
of the greatest causes of " race suicide." Its im- 
portance may be appreciated when we consider 
that in the year 1905 there were in the regis- 
stration area of the United States 545,533 
deaths, 105,553 being among children under 
five years of age, and of these 39,399 died of 
diarrhoea or enteritis. In Germany, Behring, 
who is an authority on such subjects, has 
found that, of every 1000 children born 2$$ 
die during the first year of life, that only 510 
out of every 1000 males born reach manhood 
and that not more than a third of those who 

188 



Diarrhoea and Dysentery 

reach maturity are fit for military service. 
He attributes this sad state of affairs to milk 
infection during infancy. 

For many years the great heat of summer was 
considered to be the cause of the disorder, but 
recently it has been demonstrated that it is a 
germ disease and that the heat is only a second- 
ary cause. In other words dirty milk contains 
germs which cause disease and these germs 
grow better when the milk is kept warm. 

Dr. George W. Goler, of Rochester, New 
York, has been attacking the problem, assum- 
ing that dirty milk is the cause, and his results 
have been most satisfactory. For the ten years 
from 1887 to 1896 there were 7451 deaths 
among children of five years and under. In 
1897 the work of providing pure, clean milk to 
children during the summer months was begun 
and during the following ten years the number 
of deaths was only 4965, a saving of 2486. The 
cost of this was about $1000 per year, or about 
$4 for each child saved, a small amount to pay 
for a human life. 

Similar work is being done in other parts 
of the country and we may hope for as good 
results in other places, but the real solution of 

189 



Rural Hygiene 

the problem is in the hands of the milk pro- 
ducers. It seems but just that we should expect 
them to take all reasonable precautions to 
insure the purity and cleanliness of the milk 
they offer for sale. That such precautions cost 
money cannot be denied, and the consumer 
should be willing to pay the increased cost, as 
he receives a much better article. That the 
increase in the price of milk is a serious matter 
to many is beyond dispute, and the practical 
men of the country can render the nation no 
better service than to devise some method 
whereby the cost of its production may be 
reduced without endangering its purity. The 
man who corners the milk market and advances 
the price simply to enrich himself should be 
dealt with as we deal with those who commit 
murder. 

In another section the question of pure milk 
has been considered more fully. Those who 
desire to know more of its relation to disease 
should consult ' ' Milk in its Relation to Public 
Health" Bulletin No. 41 of the Laboratory of 
Hygiene, the Public Health and Marine-Hospital 
Service, which will be found in almost any 
public library. 



XV. 

GENERAL RULES REGARDING CONTAGIOUS DISEASES 



In the less populous portions of our country 
it often happens that many hours must pass 
before a physician can be secured. If the case 
be contagious this is valuable time lost, for 
during the interval many persons may come in 
contact with the patient and become infected. 
It therefore seems advisable to include here 
some description of the more common contagi- 
ous diseases, hoping to enable the family to 
form a probable diagnosis or at least to deter- 
mine whether the disease is contagious. It is 
better to err on the safe side and assume that 
any doubtful case is transmissible than to 
make light of one that is communicable. 

Before considering the diseases severally it 
will not be out of place to give some general 
directions regarding the precautions neces- 
sary to prevent their spread. 

The ideal way to treat these cases is to remove 
them to a hospital where constant attention 

191 



Rural Hygiene 

can be had and isolation carried out. Unfor- 
tunately this is rarely possible because of the 
lack of such hospitals, and where such facilities 
are to be had many persons, from superstition 
or other reasons, dread to send their friends or 
members of their families to such institutions. 

The vast majority of diseases are treated in 
private homes, and it therefore becomes neces- 
sary to make the best provision possible to 
protect the other members of the household. 

As soon as the disease appears a physician 
must be summoned, and during the interval 
before his arrival preparations for isolation 
should be made. If possible the sick-room 
should be in a detached portion of the build- 
ing and all communication with the other 
portions of the house should be through the 
open air, but this is rarely possible. If the 
room opens into the common hall the door 
must be kept closed as much of the time as 
possible, and a sheet wrung out of a disinfect- 
ing solution hung before it. This must be 
tacked to the jamb on the hinged side and at 
the top of the frame, and in length it should 
reach the floor and allow sufficient for folding 
several times. 

192 



Contagious Diseases 

The furniture must be as scant as is consis- 
tent with the comfort of the patient. A screen 
is to be provided to ward off draughts. The 
carpet and all hangings excepting the window 
shades must be removed. Thoroughly clean the 
room, dusting with a damp cloth but never 
with a duster. 

A spit cup, bed-pan, urinal, enamel ware 
buckets, and bottles or china containers for 
disinfectants are to be provided. A small 
wooden tub will be required in which to soak 
the towels and other linen. All dishes must be 
boiled or disinfected before leaving the room. 
Generally the physician gives minute orders 
regarding the disinfection of the urine, fasces, 
and sputa, but until he comes it is wise to mix 
these with an equal volume of a solution of 
bichloride of mercury one part to five hundred 
parts of water, and allow the mixture to stand 
for thirty minutes, occasionally stirring it. 
After this it may be thrown into the closet if 
there be water disposal of the excreta, other- 
wise it should be buried. Metals or silver- 
ware must not be placed in the mercury solu- 
tion, but must be boiled. 

Only the necessary attendants are to be 
13 193 



Rural Hygiene 

allowed in the room, and all visitors must be 
excluded. Flowers may be taken to the patient 
but when wilted they must be burned if there 
be a stove or open fire in the room, otherwise 
they should be placed in a disinfecting solu- 
tion. It should be an unbreakable rule that 
nothing must leave the room unless it be dis- 
infected. This means work, but it is the only- 
safe way. 

The attendant should take several hours 
exercise in the open air each day. Before leav- 
ing the room the hands and face are to be 
washed with soap and water and then with a 
disinfecting solution. This must also be done 
before meals and after handling the patient or 
any of the excreta. A loose over-garment, 
such as a kimona, and a cap should be worn 
by the attendant while in the room. 

Many persons have an idea that all children 
must have the "diseases of childhood" and that 
the sooner they are through with them the 
better. With this in their minds many mothers 
purposely expose their children, a great mis- 
take and one that the law should take cogniz- 
ance of. Especially is it important to avoid 
measles, whooping-cough, and scarlet fever. 

194 



Contagious Diseases 

This will be more fully discussed under the 
diseases themselves. 

The school authorities should make inquiry 
as to any malady from which the child has 
suffered before admission and make it a matter 
of record. This will be found invaluable in 
cases of epidemics. 

The information here given is not intended 
to cause persons to dispense with the services 
of a physician, but rather to serve as a guide 
until he arrives and takes charge. His services 
are invaluable in cases of transmissible disease. 
He guards the household from it, watches the 
case, and is often able to turn the tide towards 
recovery, when if left alone, the result would 
be death or prolonged illness, and in some 
cases permanent deformity. 



XVI. 

MEASLES AND SCARLET FEVER 



Measles is not so prevalent in the country 
as in the city, but nevertheless the death-rate 
in the rural districts is 7.7 per 100,000. In 
Michigan in 1903 it caused a sick rate of 356 
per 100,000 and a death-rate of 5.6. 

Of 2031 cases 1301 were among children 
under five, with a mortality of 8.5 per cent., 
while of 599 cases over five the mortality was 
1.1 per cent. In other words the chances of 
recovery were 7.4 per cent, greater in children 
over five than in those under. Many mothers 
take no steps to shield their children from this 
disease, reasoning that the sooner they have it 
the sooner they will be through with it. This 
is a most dangerous practice and accounts for 
many deaths. 

The after-results of measles are frequently 
very severe. Not a few children are rendered 
deaf from inflammation of the ears following 
measles, and many cases of tuberculosis fol- 
low it. 

196 



Measles 

Measles is a disease of school children and 
most of the epidemics start in the schools. 

For the first three days the symptoms are 
watering at the eyes, running at the nose, and 
cough, or the symptoms of a common cold. 
On the third or fourth day a rash of small red 
spots appears on the face and extends rapidly 
to the entire body. The case is infectious from 
the day the first symptoms appear until the 
skin has all peeled off and appears natural. 
The discharges from the nose, mouth, and ears 
are also infectious. 

During the first days the child will in all 
probability have attended the school or mingled 
with its companions, all of whom will have been 
exposed. After exposure it is generally ten 
days before new cases appear. At times the 
infection is three weeks in developing. 

Prevention consists in isolating the patient 
until the skin has peeled and all discharges 
from the nose, ears, and throat have ceased. 
None but the persons in attendance should be 
allowed to enter the sick-room. All bedding and 
whatever comes from the room should be 
disinfected. 

The question of closing the school comes up 
197 



Rural Hygiene 

every time there is a case of infectious disease 
among the pupils. It seems the part of wis- 
dom to take the long chances and close the 
school in every case, unless the sanitary author- 
ities who investigate the matter should other- 
wise direct. This will surely reduce the num- 
ber of cases and the time lost will about even up 
in the long run. All books and other things in 
the room from which the case came should be dis- 
infected when the child is removed. 

There is a popular belief that the disease is 
particularly severe among grown persons, but 
such has not been my experience. There is 
always more or less measles among soldiers, 
and the cases that have come under my care 
have been rather milder than usual. 

SCARLET FEVER 

Scarlet fever and scarlatina are one and the 
same disease, and there is no difference in the 
seriousness no matter which name is used. 
Scarlatina is one of the most serious of the 
"diseases of childhood." During the five 
years ending with 1904 the death-rate from this 
in the rural districts of the registration area of 
the United States was less than one-half the 

198 



Scarlet Fever 

rate for the cities in the same area. In an 
epidemic in one of the counties of Michigan in 
1903 the sick-rate was 869 per 100,000. In the 
following table is shown the death-rate and the 
sick-rate from scarlet fever in two rural dis- 
tricts of Scotland. 

Years Death-rate Sick rate 

per 100,000 per 100,000 

1891-1895 23.8 716 

1896-1900 14-4 605 

1901-1905 3.4 284 

The table also shows the result of supervis- 
ion, isolation, and disinfection as applied to 
this disease. 

Scarlet fever begins suddenly, with vomiting 
and high fever, and in young children convul- 
sions are quite common. The eruption, which 
appears first on the neck and chest, comes out 
in about thirty-six hours after the first symp- 
toms, although in some cases five days elapse 
before it shows. 

After exposure the disease generally appears 
in seven days, although not infrequently as 
early as the third day. The case is contagious 
as long as there is any scaling of the skin or 
discharge from the nose, mouth, or ears. It 
can be transmitted through the medium of 

199 



Rural Hygiene 

milk, clothing, furniture, toys, dishes, bedding, 
carpets, cats, and dogs. There is likewise 
evidence to show that it may be carried to a 
third person by an intermediate person, who 
does not contract it. 

The acute symptoms last about ten days and 
are often followed by serious disorder of the 
kidneys. 

Deafness is another of the after-effects, and 
when it develops before the child has learned 
to speak, the child remains a mute. This and 
the fact that the mortality is much less after 
the age of ten is passed, shows the importance 
of preventing the disease if possible. To ex- 
pose a child purposely to scarlet fever is a 
crime and should be dealt with by law. 

From a study of the ways in which the malady 
is transmitted, it will be seen that the room in 
which a case is treated should be as bare of 
hangings, furniture, and carpets as possible. No 
unauthorized person should be allowed ad- 
mittance, and everything leaving the room 
must be disinfected. The writing of letters by 
those sick or convalescent must be prevented, 
as frequently the disease is transmitted in this 
way. Toys that have been used by the sick 

200 



Scarlet Fever 

child during its illness must be destroyed. 
Clothing that has been used during the sick- 
ness should be also destroyed unless it is of 
great value. In such a case it may be sterilized 
by steam. The woodwork and walls should be 
washed with bichloride of mercury solution. 



XVII. 

DIPHTHERIA AND SMALLPOX 



Diphtheria usually begins with a sore 
throat and fever. Examination of the throat 
will show a grayish or whitish membrane on it 
or the tonsils. There are other diseases in 
which there is a membrane in the throat, but, 
owing to the seriousness of diphtheria, it is best 
to consider all cases with membrane in the nose 
or throat as diphtheria and to isolate them 
and send for a doctor at once. 

The malady is caused by a germ which is 
found in the throat and is given off from the 
body in the excretions from the mouth, nose, 
and throat. The disease also prevails in dogs, 
cats, and other animals, and is at times trans- 
mitted to man from such sources. Milk, as 
usual, is one of the most common carriers of 
the germs. There are cases of the disease which 
are so mild that the sick person is not confined 
to bed, but does the usual daily work. If such 
a person be employed about the dairy the milk 

202 



Diphtheria 

which passes through his or her hands will 
almost certainly be infected, and many epi- 
demics have been traced to this source. The 
infection can also be transmitted by books, 
toys, dishes, and clothing. 

After exposure the disease may develop in 
twenty-four hours, but more commonly it does 
not manifest itself until the third day. 

When it develops in a school child the other 
children should be examined with care, as not a 
few cases are frequently found among them. The 
school should be closed, and the children kept 
under observation until the danger is passed. 

The prevention consists in isolating those 
sick with the disease and the administration of 
antitoxin to the patient and also to those who 
have been exposed. The early use of antitoxin 
will save many lives and prevent many persons 
from having the malady. 

From 1888 to 1894 there were treated in the 
Boston City Hospital and its South Depart- 
ment 3067 cases of diphtheria, with 1325 
deaths, a mortality of 43.2 per cent. Since 1895 
antitoxin has been used exclusively and the 
number of cases treated has been 18,198, with 
2079 deaths, a mortality of 11.4 per cent. 
203 



Rural Hygiene 

Had the previous rate prevailed there would 
have been 5773 more deaths. 

There is no danger in the use of antitoxin 
that is prepared by reliable houses and issued 
under the supervision of the National Govern- 
ment. Occasionally there have been cases of 
unfortunate results following the administra- 
tion of the serum, but there have been none 
for some years and under the careful super- 
vision now maintained there will be none in 
the future. Next to vaccine there is no other 
discovery that has conferred so much benefit 
upon the human race. Those who oppose its 
use should make a careful study of the statistics 
of hospitals where the disease is treated, com- 
paring those for the period immediately pre- 
ceding and after the use of the serum, and unless 
they are unable to be convinced by plain sta- 
tistics their opposition will vanish. 

We still hear of persons who maintain that 
sewer gas and the emanations from manure 
will cause the disease. This is not a fact, but 
such gases may have an indirect effect by so 
reducing the general health of those who 
breathe air so contaminated that they are ren- 
dered susceptible to any disease. 

204 



Smallpox 

SMALLPOX 

Smallpox is comparatively rare in this coun- 
try, although there is, every now and then, an 
outbreak which shows that the disease is still 
to be reckoned with. In the Philippines and 
Porto Rico at the time of the American occu- 
pation it was very common. In the town of 
Mangataren in the Philippines 26 per cent, of 
the inhabitants were "pock marked, " and as 
many more who showed no marks claimed to 
have had the disease. 

Smallpox begins abruptly, frequently with a 
chill, intense pain in the back, severe headache, 
and great prostration. Soon small red spots 
appear on the arms, neck, or at the roots of the 
hair. These increase in number and extend all 
over the body. They become larger and fill 
with serum, which changes to pus; then they 
dry up. 

The exact method of transmission is un- 
known, but it appears that the infection is 
given off from the body and transmitted through 
the air. It can also be carried by domestic 
animals, clothing, furniture, or carpets. 

The sick should be isolated in a building 
remote from the public road or dwellings. A 

205 



Rural Hygiene 

distance of four thousand yards is recom- 
mended, but it is not always possible to obtain 
such a situation. The quarantine should be 
continued for sixteen days after the last symp- 
toms have disappeared. All persons who have 
been exposed to it should be vaccinated and 
held under observation for sixteen days. 

Vaccination, if properly done and repeated at 
intervals of five years, will practically prevent 
contraction of smallpox. The following table, 
prepared by Doctor Barry of Sheffield, England, 
should convince any fair-minded person of the 
value of vaccination. 

Individuals Living in Houses Invaded by Smallpox. 

Over ten years Under ten years 

of age of age 

TT . - f Attacked 28. i per cent. 7.8 per cent. 

Vaccinated . . < ~. , r 1 r 

I Died .... 1.4 per cent. o . 1 per cent. 

TT . L ,f Attacked 68 . o per cent. 89 . 9 per cent 

Unvaccmated { ~. , l 

\ Died. ... 37.1 per cent. 38.1 per cent. 

In the vaccinated the difference between the 
rates for children under ten and those older is 
due to the fact that nearly all children are 
vaccinated when they enter school, but com- 
paratively few after completing their educa- 
tion. The table speaks loudly for re vaccina- 
tion. 

206 



Smallpox 

The British Royal Vaccine Commission re- 
ports the following statistics: 





Cases 


Died 


Per cent, died 


Vaccinated. . . . 


• 8744 


461 


5-o 


Un vaccinated. . 


. 2321 


822 


35-1 



There are in this country a few misguided 
persons who have developed a most violent 
prejudice against the use of vaccine. They are 
prepared to paint the rare accidents, which have 
followed the careless use of the virus, in the 
most vivid colors. They tell their hearers that 
all manner of dreadful diseases have been con- 
tracted from its use. As a matter of fact there 
have been accidents, which are not to be de- 
fended, but very few if any will now occur. 
During the past few years the National and 
State Governments have taken precautions 
which will preclude accidents. The author 
has vaccinated more than ten thousand per- 
sons, and has never met with a case of lockjaw, 
or other disease which could even remotely be 
charged to the vaccine. There will always be 
some soreness of the arm when the operation 
has been successful, but if the physician uses 
proper aseptic precautions in doing the opera- 
tion, and the patient keeps the arm clean and 

207 



Rural Hygiene 

refrains from scratching it, very sore arms will 
not be encountered. 

According to the Interstate Commerce Com- 
mission there were, during the year 1906, 106 18 
persons killed and 97,706 persons injured by 
the railroads in the country, yet we hear of no 
persons who tour the country endeavoring to 
persuade the people to stop using the railroads. 
It would seem if the persons who are now 
preaching against vaccination are really anx- 
ious to save their fellow countrymen from 
suffering they would devote their energy to 
endeavoring to find some preventive for the 
terrible slaughter dealt out by the railroads. 

Vaccination is without doubt one of the 
greatest blessings which has ever come to the 
human race, and every man, woman, and child 
should honor Edward Jenner and his teacher, 
John Hunter, who made it possible for the 
former to discover vaccine. For the sake of 
humanity do not oppose the vaccination, but 
endeavor to make it compulsory in your schools 
on admission, and revaccination a prerequisite 
before the child can enter the grammar or 
high school. 



XVIII. 

WHOOPING-COUGH AND TYPHOID FEVER 



Whooping-cough is a highly contagious 
disease of the respiratory tract, characterized 
by periods of spasmodic coughing followed by 
a prolonged inspiration which is the cause of 
the whoop. This is one of the most fatal dis- 
eases of young children and is not infrequently 
followed by pneumonia or tuberculosis of the 
lungs. 

At first it appears to be only an ordinary 
bronchitis (cold), but sooner or later the char- 
acteristic symptoms develop. The disease lasts 
a long time and is infectious from the beginning 
of the bronchial symptoms until some time after 
the child is entirely well. It requires careful 
nursing, and those sick must be isolated and 
all articles with which they have come in con- 
tact disinfected. Cloths used to receive the 
discharges from the nose or mouth must be 
burnt at once. A cloth must be held in front 
of the mouth when coughing to intercept the 
14 209 



Rural Hygiene 

small drops which are then expelled from the 
throat. The sputum must be disinfected. 

TYPHOID FEVER 

This is one of the preventable diseases which 
causes no end of misery and many deaths in 
this country. 

For the five years ending with 1904, in the 
portion of the United States where accurate 
statistics of deaths are kept, 28 persons out of 
every 100,000 in the rural districts and 26 in 
the cities died from it. In one county in 
Michigan in the year 1903 the sick-rate from 
typhoid fever was 495 per hundred thousand, 
while for the rest of the State it was 128. 
Many of the cases that are credited to the cities 
are, in reality, contracted in the country. 

The duration of the disease is about five 
weeks, during which time those afflicted are 
unable to earn anything and are a source of 
expense to themselves and to their families. 
Considering the time lost and the deaths, it is 
estimated that the loss to New York State 
amounts to $7,000,000 per year. As typhoid 
fever is distinctly preventable, most of this loss 
is unnecessary. 

210 



Typhoid Fever 

The germs are given off from the body in the 
faeces, the urine, and the excretions from the 
skin. 

The disease is transmitted to man through 
water, milk, and other foods, and by direct 
contact with infected clothing or other articles. 

Water becomes contaminated by receiving 
the excreta from those sick with the disease. 
This may occur through the medium of the 
sewer, the privy, the cesspool, or through the 
washings from the ground upon which the 
infected faeces have been thrown. Not infre- 
quently the fasces are thrown into a stream. 
In the summer and fall of 1905 the little town 
of Nanticoke, Pennsylvania, with a population 
of 1500 persons, was visited by an epidemic of 
437 cases with 50 deaths. Upon investigation 
the State Board of Health ascertained that 
some weeks before the appearance of the dis- 
ease in the town, a man who lived on the water- 
shed from which the town derives its supply, 
was taken sick with typhoid fever and that the 
faeces, which were apparently not properly dis- 
infected, and the other refuse from the house 
were thrown into a small stream running 
beneath it. This emptied into a swamp 

211 



Rural Hygiene 

drained by the stream from which the town 
took its water supply. 

Had proper precautions been taken in that 
case the town would have been spared the 
epidemic. For similar illustrations see the 
section on water. 

Milk becomes contaminated by being placed 
in containers that have been washed with water 
in which are the germs. In some cases the infec- 
tion comes through the hands of milkers who 
have been in attendance on the sick or who have 
just recovered from the disease. 

The fly is the great distributor of the germs. 
He delights to feed on infected faeces and then 
without "wiping his feet" adjourns to the milk- 
house or kitchen for dessert, and, alighting on 
the milk or other food left exposed for his bene- 
fit, promptly transfers the infection thereto. 
This was the way the disease was disseminated 
throughout our military camps during the war 
with Spain. 

Blankets soiled by typhoid patients were 
also one of the means of spreading it in 1898, 
and an epidemic in London was traced to 
blankets which had been used in the hospitals 
in South Africa during the Boer War. 

212 



Typhoid Fever 

Shell-fish that have been fattened near the 
outfalls of sewers have been found to be in- 
fected, and I know of a case of a lady who was 
infected by eating raw clams taken from a 
beach some distance from the mouth of one of 
the sewers which pollute the waters of Boston 
Harbor. 




Fig. 19. The house fly, Musca domesUca : larva with details at 
right, puparium at left. " The fly which does not wipe his feet." (From 
Howard, Bulletin 35 N. S, Division of Entomology, United States 
Department of Agriculture.) 

In New York City it has been found that 
around the mouths of the city sewers there are 
belts in which typhoid fever is very prevalent. 
Further investigation has shown that much of 
the fecal matter floats on the surface and 
finally lodges on the piles of the docks. Flies 
caught in such localities are teeming with germs, 

213 



Rural Hygiene 

many of which come from the human intestines. 

Travelling mendicants and, in fact, other 
travellers not infrequently infect the water 
supply of the region through which they pass. 
A case is recited of a man who was taken sick 
at a tavern where he had stopped for the night. 
His excreta were thrown on the ground with- 
out being disinfected, and in a short time the 
disease attacked the family of the tavern 
keeper and later half of the population of the 
neighborhood, resulting in ten deaths. All the 
houses in which it appeared used the water 
from the tavern well. 

The prevention consists in destroying the 
germs as soon as they leave the body. If this 
were done in every case the disease would soon 
die out, but this seems to be impossible at 
present. Under the headings of food, water, 
and milk, have been given directions for keep- 
ing these pure. Every effort should be made 
to keep flies from the milk or other food, and 
as far as possible all breeding places should be 
abolished. 

To destroy the germs of typhoid fever the 
faeces, sputa, and urine must be mixed with 
equal parts of a solution of the bichloride of a 

214 



Typhoid Fever 

strength of i part to 500. A 5 per cent, solu- 
tion of carbolic acid may be used, but it is not 
so good. These mixtures must be stirred 
from time to time so that the disinfectant shall 
penetrate to all parts, and after standing for 
at least two hours they may be thrown into the 
closet or buried. No solution containing a 
disinfectant must be thrown into a dry earth 
closet. 

All dishes and linen that have been in con- 
tact with the patient should be soaked in a 
similar solution. Silverware must not be 
placed in the bichloride, but should be boiled. 

The attendant's hands should be washed in 
a solution of bichloride of mercury 1 part to 
1000 every time the patient is handled, and 
especially after handling the bed-pan or urinal. 
Before eating, the hands and face must be 
washed in soap and water and then in the solu- 
tion just mentioned. 

Where these measures have been carried out 
there has been a great reduction in the num- 
ber of cases. In one county in England these 
precautions have resulted in a reduction in the 
sick-rate from 315 per 100,000, in 1893, to 93.2, 
in 1905. 



XIX. 

TUBERCULOSIS 



This has been called the "universal disease," 
and there are few families in this country who 
have not had some experience with it. It 
causes more deaths and more suffering than 
any other. In 1900 there were 111,059 from 
this disease in the United States. In New 
York State, from 1884 to 1907, it caused ti 
per cent, of the deaths, and the Commissioner 
of Public Health estimates that it costs the 
State $70,000,000 each year in sickness and 
death. 

Being no respecter of persons, it attacks the 
rich as well as the poor, but prevails more in 
the crowded tenements of the large cities. 
It is found in all parts of the globe, even 
among people who live largely in the open air. 
On our Indian reservations it prevails to such 
an extent that the tribes are rapidly being 
exterminated by it. Among cattle it causes a 
great mortality. Professor V. A. Moore, of 

216 



Tuberculosis 

Cornell University, states that of 8649 cattle 
tested with tuberculin in New York State 36 
per cent, were found to be infected, and of 
364 herds tested 72.8 per cent, responded. In 
Prussia 12.7 per cent, of the cattle killed in 
1905 were found to be tuberculous. In Saxony 
in the same year 2.7 per cent, of the swine 
killed showed evidences of the disease. In the 
large packing houses of this country less than 
1 per cent, of the animals killed are infected, 
but in the small establishments where "home 
killed beef" is slaughtered the percentage is 
much larger. This is mainly because the large 
houses receive their cattle from the plains where 
the animals live in the open air, while the small 
butcher obtains his from the infected pastures 
of the local community. 

Tuberculosis is a preventable disease and 
with proper precautions can be stamped out. 
It is transmissible to persons through the 
medium of germs which are given off in the 
expectoration and in the minute drops of mucus 
which are expelled during the act of coughing. 
It is not transmitted through the breath, as has 
been conclusively proven by experiments with 
animals, which are far more susceptible than 

217 



Rural Hygiene 

human beings. There is no reason for the dread 
which has taken hold of some of our people 
and which causes them to shun those who have 
the disease. Persons with tuberculosis are not 
dangerous to the community as long as they 
exercise care regarding coughing and in dis- 
posal of their expectoration. 

In cattle it is transmitted in the same way 
and in addition the germs are found in the milk 
and the faeces. 

The conditions that predispose to the disease 
are bad food, alcohol, bad ventilation, and 
excesses of any kind. Against t'hese we must 
contend if the disease is to be eradicated. 

The prevention consists in enforcing regula- 
tions against expectorating in public places, 
both by law and by public sentiment, which is 
stronger than the law. Cuspidors of proper 
construction, filled with a disinfecting solution, 
must be provided for public places, and those 
who are known to be suffering from the disease 
must be required to provide themselves with 
proper spit cups or other receptacles for their 
expectoration. They must also hold a cloth or 
absorbent paper before the face while coughing. 
Milk from tuberculous cows must be excluded 

218 



Tuberculosis 

from the market, and the dairy cattle must be 
tested with tuberculin at frequent intervals. 

Many cattle which are apparently healthy 
give off millions of germs in their milk. The 
illustration (Fig. 21) is of a cow which was 
furnishing part of the milk supply for the city 
of Washington, and upon examination was 
found to be badly infected with tuberculosis. 

Some years ago, in their anxiety to rid the 
community of cattle infected with tuberculosis, 
some of the States passed laws requiring that 
all such animals should be killed, the State 
paying the owner a part of or the entire value 
of the animal. It was soon demonstrated that 
such a policy would bankrupt any State. 
Professor B. Bang, of Copenhagen, Denmark, 
has devised a better and more economical 
method of accomplishing the desired result. 
He causes all the cattle of the herd to be in- 
spected, and those which show symptoms of 
the disease, cough or emaciation, are killed. 
All others are tested with tuberculin and those 
which react are separated and kept in distant 
pastures and stables which do not communicate 
with those in which the healthy animals are 
kept. All calves born of the infected cows are 

219 



Rural Hygiene 

at once taken from the mothers and fed on milk 
from healthy cows or upon their mothers' milk 
after it has been pasteurized. The well herd is 
watched with care and tested at least once a 
year. Any cattle which become sick or react 
are dealt with as the case demands. In this 
way it is possible to restock a herd from cattle 
which have tuberculosis, and at the same time 
get rid of the disease. This method is being suc- 
cessfully tried in many places in this country. 

No animal should be added to the herd until 
it has been tested and found free from tuber- 
culosis. 

The housing of cattle has not received the 
attention it demands. Good ventilation usually 
means a cold stable, and a cold stable means 
reduction in the output of milk. As has been 
aptly said, some of our milk producers find it 
cheaper to keep their cows in badly ventilated 
but warm barns than to properly house them 
at an expense which reduces the profit on the 
milk. Few barns provide more than 600 cubic 
feet of air per animal, but the amount should 
not fall below 1200 cubic feet. The question of 
feeding and housing has been considered under 
the subject of milk. 

230 



p 
cS I 

g "« 
a c OT 
>§£ 

— C O 

II 

o&r 

OTO 

IS 

S3 

h 

B 



3? 
aw 

e 0- 





Fig. 21. — An apparently healthy cow recently in a herd supplying 
milk to Washington, D. C. Tubercle bacilli were found in her milk and 
fasces. When killed her udder and intestines were found to contain small 
tubercular nodules. (From a photograph taken by the Bureau of Animal 
Industry, published by permission of Dr. E. C. Schroeder.) 





Fig. 22. — A. Mesentery of the preceding cow showing tubercular 
nodules. B. Part of chest wall of the same cow showing tubercular 
nodules. (From a photograph taken by the Bureau of Animal Industry, 
published by permission of Dr. E. C. Schroeder.) 



Tuberculosis 

There are persons who claim that the milk 
from tuberculous cows is safe unless the udder 
is the seat of the disease, yet it has been proven 
that cows apparently in the best of health may 
pass the germs in their fasces. Nearly all milk 
contains a small amount of cowdung, and where 
the cow passes the bacilli of tuberculosis in her 
faeces they will always be found in the milk. 

Personally we can do much to protect our- 
selves from tuberculosis. Our greatest asset 
in this warfare is a strong body that has not 
been undermined by excesses. Next comes 
fresh air and exercise in the fresh air. Sleep- 
ing with the windows open is no hardship, even 
in the coldest of weather. Our ancestors lived 
in rooms without fires, and the numerous 
cracks allowed the snow to filter in, yet they 
were healthy. If the room becomes very cold 
with the windows open, another room that is 
heated should be used for dressing. Many 
persons with tuberculosis are sleeping out of 
doors all the year round, even in the severe 
climate of our northern States. 

Do not be afraid of sunlight. The draperies 
which we hang about the windows no doubt 
look very pretty and make the room more 

221 



Rural Hygiene 

exclusive and save the carpets, but in shutting 
out the light we are shutting in the germs of 
disease. There is no better disinfectant than 
strong sunlight. 

When you have a "cold" go to a physician 
and have him treat it before it becomes serious. 
A "cold" that hangs on or is slow in leaving is 
probably something else, more likely tuber- 
culosis. This is true of "cases of la grippe," 
from which the recovery is slow. If you have 
a cold or a cough that persists, do not trifle 
with home remedies, but consult a physician 
at once and be prepared to be thoroughly 
examined and to do what he says. If taken 
early tuberculosis is almost always curable, but 
if allowed to run on the chances of recovery are 
greatly reduced. Do not spend your money 
for the consumption cures which are advertised 
so widely. They never cure, but do harm by 
causing delay in beginning proper treatment at 
a time when a few weeks may mean life or 
death. Above all avoid alcohol in any of its 
forms; it will not give you strength, but will 
add fuel to the fires of the disease which is 
consuming your body. 



XX. 

RABIES (Hydrophobia) AND RATS 



Rabies is a disease of animals and of man. 
The dog seems to be most subject to it. For 
many years it was maintained that it was com- 
paratively rare in this country, but recent 
studies have shown that it is anything but rare. 
In the registration area, which comprises the 
States of Connecticut, Indiana, Maine, Massa- 
chusetts, Michigan, New Hampshire, New York, 
New Jersey, Rhode Island, and Vermont, there 
were, during the five years from 1900 to 1904, 
two hundred authenticated cases of hydro- 
phobia. In the District of Columbia during 
the six months ending July 1, 1908, sixty- 
eight animals were attacked by it, and for the 
seven years from 1893 to 1900 twenty-eight 
persons suffered from this disease. This seems 
a large tax to which we willingly submit in 
order that the dog may enjoy privileges not 
allowed to other animals. 



223 



Rural Hygiene 

Rabies prevails at all seasons and is about 
as frequent in winter as in summer. 

Not every dog infected runs wild on the 
streets foaming at the mouth, for in not a few 
instances the animal seems but slightly sick 
and is only a little restless. These cases are 
very dangerous, as their owners are liable to 
caress the animal at such times and become 
infected. 

The most important step in the prevention 
of this disease is to have all dogs muzzled 
whenever they are on the public streets, no 
matter whether they are in the leash or not. 
This is quite common in Europe, and in every 
case where it has been done the disease has 
practically disappeared. Some of our people 
will object, on sentimental grounds, to the use 
of muzzles, but if properly fitted the dog is 
not injured in the least and will be saved from 
many a bite from his fellows. 

A dog the least bit sick should be watched 
with great care lest he be suffering from this 
disease. If there is the slightest suspicion about 
a dog which has bitten a person it should be 
killed at once and its head sent to a laboratory 
where it can be examined. Persons who have 

224 



Rats 

been bitten should receive the Pasteur treat- 
ment immediately. The expense should be 
charged against the person owning the dog, 
and, should he be unable to pay, the public 
should furnish the funds. This is sound teach- 
ing from an economical as well as from a sani- 
tary standpoint, and will tend to reduce the 
number of unmuzzled dogs to the minimum. 
A community which does not properly protect 
its citizens should pay for any damages they 
sustain from the lack of such protection. 

RATS 

Rats are not desirable inhabitants of the 
home or of the barn. They destroy an im- 
mense quantity of grain and other valuable 
produce, besides eggs and young chickens. 
Rats which live at the slaughter-house feed 
on the refuse and become infected with para- 
sitic diseases, especially trichinosis. These are 
in turn transmitted to hogs which devour the 
dead rats about the slaughter-house. 

Rats suffer extensively from plague, and the 

infected fleas which are found on their bodies 

are the means of transferring the disease to 

man. Plague is practically unknown in the 

15 225 



Rural Hygiene 

United States, but it has had a footing in San 
Francisco for over nine years, and has gradually 
extended its territory, resisting the efforts of 
the sanitary authorities of the city and State. 
It is epidemic in many of the ports of South 
America. Once it is established in a country 
it is eradicated with difficulty, and its ravages 
are something appalling, especially where there 
is an extensive population that is ignorant and 
careless of sanitary precautions. In India the 
mortality from plague during the year 1905 
was 878,602. It is not at all improbable that 
it may gain a footing in some of our eastern 
or southern cities. Should such a thing happen 
the man would be indeed well off whose premi- 
ses are free from rats. 

Rats may be excluded from the house by 
closing up all holes, especially those around 
the sewer and water pipes, and by blocking up 
the space between the plastering and the walls. 
The cellar floor should be laid in cement, and 
a good cat kept on the place. Corn cribs and 
similar buildings may be made rat proof by 
covering the walls and floor with stout wire 
netting, which is strong enough to resist the 
teeth of the animal. The usual method of plac- 

236 



Rats 

ing an inverted tin pan upon the top of each 
post upon which the building rests frequently 
fails, because the rat can jump from the pole 
to some hole in the floor of the building. 

Rats may be destroyed by trapping, fumiga- 
tion, poisoning, and by the use of certain germs 
which are deadly to rodents but harmless to 
man. Ferrets are also useful. In India it has 
been learned that where there are many cats 
plague is very rare, because these keep away 
the rats and apparently do not suffer from the 
disease. 



XXI. 

PELLAGRA 



This is a chronic disease which seems to be 
in some way connected with particular locali- 
ties. It has long been known in Italy, and other 
countries in Southern Europe where it is sup- 
posed to be caused by the use of foods made 
from spoiled corn. Since 1907 it has been known 
in the Southern portion of the United States, 
and seems to be increasing rapidly. Sporadic 
cases have been reported from many other por- 
tions of the country. It is estimated that over 
30,000 persons have been attacked since 1907 
and that the mortality has been about 39%. 

This disease prevails more amongst the 
whites, especially amongst the white women, 
and is more common between the ages of 20 and 
49 years. In Europe it is a disease of rural com- 
munities and isolated farms, but in this country 
it prevails more in small villages. Poverty is a 
predisposing cause. The mortality amongst the 
black race is greater than amongst the whites. 
228 



Pellagra 

Opinions are divided as to the cause of the 
disease. Many still hold to the older theory 
that spoiled corn is the cause, while the newer 
theory is that although it seems to be in some 
way connected with the food supply, there 
seems to be good reason for believing that the 
sand fly is the means of transmitting the disease 
from person to person. In Italy the disease 
seems to follow the streams in which these flies 
breed. Cases have been recorded amongst 
persons who do not use corn. 

The disease generally begins with indistinct 
nervous systems, but later there are symptoms 
referable to the stomach. At this time there 
may be headache, dizziness, and muscular weak- 
ness, with an eruption on the skin, especially 
the portions that are exposed to the light. Still 
later there are marked nervous symptoms, and 
not infrequently insanity. In one asylum 6.3% 
of the inmates were found to be suffering from 
this disease. 

As we know nothing definitely regarding the 
cause nor the mode of transmission our efforts 
at prevention must be more or less general. 
Spoiled corn is not a proper food and should not 
be used. In localities where the disease prevails, 
229 



Rural Hygiene 

those who desire to escape the disease should 
avoid the use of corn as much as possible. As 
the disease is limited to certain localities one 
should keep away from those places where it is 
known to prevail. To protect one's self from 
the biting flies, not only makes life more com- 
fortable, but if the disease is transmitted by 
them one is protected from pellagra. 



230 



XXII. 

ACUTE ANTERIOR POLIOMYELITIS 



This disease is also called infantile paralysis, 
but as adults are frequently attacked by it it 
seems best to drop that name. 

It has increased very much during the past 
ten years and there have been quite a number of 
severe epidemics during that period. The 
United States seems to have suffered more than 
other countries, something like 7,000 cases hav- 
ing been reported between the years 1905 and 
191 1. In the registration area of the United 
States the death rate has averaged 1.5 per 
thousand. 

It is apparently a contagious disease, and the 
contagion has been proven to reside in the 
mucous membrane of the nasal cavity and in 
the spinal cord of persons who have the disease. 
By inoculations with portions of the spinal cord 
monkeys have been infected and the disease 
has been transmitted through a long series of 
animals by this means. It has also been proven 
231 



Rural Hygiene 

that the disease can be transmitted through the 
medium of the stable fly, but whether this is 
the usual method of transmission it is impossible 
to say. 

Most of the epidemics in this country have 
been confined to the northern states and those 
east of the Dakotas, but this appears to be but 
a coincidence. It prevails more during the 
summer and fall months. 

The onset is usually sudden, although there 
are cases that are preceded by weakness, 
digestive troubles, and nervousness. There is, 
however, generally a rapid rise in temperature, 
with high fever, pain in the back of the head 
and extreme prostration. The patient is rest- 
less, drowsy, with pain in the neck and along 
the spine, and generally paralysis in one or 
more extremities, generally the legs, rapidly 
develops. 

As we are not certain as to the direct means 
of propagation of the disease our attempts must 
be more or less general. The patient should be 
isolated, and the rest of the family and those 
who have been exposed quarantined for at least 
three weeks. All the discharges from the nose 

and mouth should be burned, and when cough- 
232 



Acute Anterior Poliomyelitis 

ing the patient should hold a cloth or paper 
napkin before the face. When the patient is 
unconscious a mask should be worn. All persons, 
especially the children, should be protected from 
the flies. 

During epidemics children should be kept off 
of the streets and from crowded places. 

After recovery the house should be disin- 
fected. 



*33 



DFC 3 1913 



